1. K

    Contracted with Medicare/other insurances but not Medicaid

    If a practice is contracted with Medicare and other commercial insurances, but not medicaid.. Does the patient legally have to pay their primary insurance co-pay? For example, the patient's primary insurance is United, but their secondary is some type of medicaid plan. If United decides there...
  2. R

    Question Utah Medicaid Billing for IOP services (HELP!)

    We are new to Utah Medicaid, and unfortunately they do not accept H0015 for IOP for SUD. I am at a loss for what I am supposed to bill. Does anyone have any guidance with Utah Medicaid billing??
  3. B

    Question E&M coverage for private insurance vs Medicaid

    Hello. I live in AZ and we have state Medicaid (AHCCCS). I have a question regarding dual (or more) insurances and billing E&M codes. I have patients that have private insurance (i.e. BCBS/UHC/Cigna) as primary and Medicaid as secondary. Do I use the E&M code (i.e. G0108) that I know the...
  4. D

    Question Nevada Medicaid Denials

    I am new to medical billing. I work in a public health clinic and we bill for immunizations primarily. The claims were first denied because our provider wasn't linked to our Medicaid group. After that was fixed I did a little research and I now know that Medicaid will not cover the vaccines...
  5. B

    Question Nuchal cord in delivery

    When a delivery summary states "nuchal cord x1, loose, slipped over head" does that require the O69.81X0 Labor and delivery complicated by cord around neck, without compression, not applicable or unspecified? I'm in Vermont and Medicaid is denying claims stating the O69 code cannot be primary...
  6. J

    Medicare COB Question for IP Stay

    When a member becomes eligible for Medicare Part A in the middle of their Inpatient stay, how is the biller to submit a claim? The patient had Medicaid State SSI as coverage upon admission which fell to secondary payor once the patient was entitled to Medicare Part A. Is SSI responsible for the...
  7. L

    Billing Medicaid patients for unpaid covered services?

    Hello, A private company that offers plans for patients that are found eligible for Masshealth (Medicaid) has been inconsistent with payment of services. We have quite a few patients that have claims that should be covered and the insurance company acknowledges their error in denying their...
  8. A


    my group provides mental behavioral health services, psychology/psychiatry, in nursing facilities that we're contracted with in 5 states. Medicaid KEEPS denying our 99484, 99358, and 99359 claims. Is there a specific way aside from the requirements we're all aware about of a claim form that may...
  9. J

    Question Antepartum, Delivery, and Postpartum Care Medicaid Billing

    Hello, I work for a large Ob-Gyn practice and we were looking to see how other large practices handle billing Medicaid antepartum, delivery, and postpartum care. For example: We have a patient who we provided antepartum care by various providers of the same group, delivery, and postpartum...
  10. E

    Question CMS/Medicaid Pay To Provider Question

    Hello, We have been having problems with our billing system where MEDICAID claims are paying to the member's PCP, not the rendering provider. Before going to the manufacturer to get changes to our billing system, is this a Medicaid or CMS rule/regulation? I have searched their website through...
  11. K

    Medicaid overdue claims

    We received denial from Medicaid coverage guidelines were exceeded. Rep suggest to fill application on web-portal. I am a bit confused. Any suggestions
  12. G

    Denials from medicaid

    Hello, I have run into an issue with Medicaid stating that 1) L21.0 has an age limit. This I don't understand because this is a code for Dandruff and anyone can get dandruff at any age? However there are no other appropriate codes to assign to this patient from the medical record. 2)...
  13. J

    Outpatient hospital billing under new EAPG payment system

    We bill as an outpatient dept of a local hospital (not an ASC) How are bilateral procedures supposed to be billed? We always billed Medicaid and Medicaid Replacement plans with 2 lines, the first w/ RT modifier and the second w/ LT modifier. They would not accept modifier 50. Now they are...
  14. J

    Eligibility Verification

    Does anyone have any good advice on the best way to set up auto-eligibility verification? Any examples of software applications that are really efficient? We are wanting to have an automated process that will generate a report for our persons served receiving Medicaid coverage. We are located...
  15. A

    Encountering multiple services for open Medicaid client

    I work for a Medicaid managed care organization and am wondering about the appropriateness around encountering/billing multiple services for a client when the client is open to services in multiple facilities. For example, if a client is in a psychiatric residential treatment facility, can a...
  16. Rebecca Pate

    Vitamin D Deficiency and Medicaid

    Since Medicaid does not accept any unspecified codes, and the only code available for Vitamin D Deficiency is unspecified (E55.9), what is everyone doing? Can we not ever use this for Medicaid? Any help would be appreciated. :confused::cool:
  17. S

    Billing Medicaid first for medical or billing Medicaid Amerihealth first

    I'm new to billing and coding. When patient has both, which one do we bill first for a medical Dx, medicaid Avesis or Medicaid AmeriHealth? :p
  18. J

    PA Medicaid Requirements

    I bill and code for a pediatric practice in Pennsylvania. Recently Medicaid updated their EPSDT schedule and they are requiring we use 96160 for administering a depression screening to a caregiver. Obviously it should be 96161. I am looking to see if anyone has had experience with getting...
  19. D

    new to OB coding - some basic questions re: FL Medicaid

    Our practice has midwives and an ARNP only. No physicians in this specialty. I think i'm doing fine on the deliveries, but i'm finding it difficult to locate info on how to bill for office services. Medicaid has limited information in their manual. Does anyone know of a more instructive article...
  20. A

    Billing for services before MH assessment?

    I work for a Medicaid organization and am wondering if it is appropriate to bill for services before an assessment is done. For example... 1. Case Manager works on paperwork for a member for 30 minutes for housing prior to taking them face to face to Housing Authority for 1 hour- Can they bill...
  21. P

    Incident-to ILLINOIS Medicaid

    Is it true that Illinois Medicaid does NOT follow incident-to guidelines for nurse practitioners? I do not see any evidence of it in the Practitioner Handbook, but wanted to see if there is something I am missing. Thank you!
  22. C

    Post Op Cataract Visits

    We have recently discovered that because we are an Optometry office, Medicaid will not reimburse us anything for the patient's post op cataract visit. Since we cannot bill 66984 to Medicaid, does anyone know if we can still bill a 99213 OV code with the cataract dx or is this considered fraud...
  23. A

    No Show Fee for Medicaid?

    Hello! Does anyone know where I can find information as to whether an office can charge a Medicaid patient a no show fee or not? I am finding several different answers. I work in North Carolina. Thank You!
  24. S

    Charging Medicaid Pts for Chiro visits exceeding the coverage limit?

    In California, there is a twice monthly limit on covered benefits for Chiro. If a Medi-Cal (Medicaid) Pt wants additional visits of the sort, are we allowed to chage them? I know that we can charge for uncovered benefits and we frequently do, in dental, particularly. But these are covered...
  25. C

    Z36 - Medicaid

    In our office we will do a dating ultrasound in which we use Z36 and Z3A. Patients are also offered genetic screening, some will have a specific diagnosis that we can use but for other simply wanting it for peace of mind we have been using the code Z36 also. Up until recently we haven't had a...
  26. D

    Medicare/Medicaid secondary: HCPCS services non covered by Medicare paid by Medicaid

    Hi, I work for a community mental health center and most of our services that we render are HCPCS and covered by Medicaid. My question is: Since the services are not covered by Medicare do we bill Medicaid directly or do we still need to bill Medicare as primary? I have asked this question...
  27. A

    Billing Medicaid for Postoperative Eyeglasses for Cataract Surgery

    I work in an ophthalmology office and am constantly billing post operative eyeglasses for cataract surgeries to DME and have had no problem getting them paid. (We use CPT codes V2303, V2305, etc. and ICD-10 code Z96.1). I have recently tried billing Medicaid for a pair of post operative...
  28. A

    Billing Post Op Eyeglasses after Cataract Surgery to Medicaid

    I work in an ophthalmology office and am constantly billing post operative eyeglasses for cataract surgeries to DME and have had no problem getting them paid. (We use CPT codes V2303, V2305, etc. and ICD-10 code Z96.1). I have recently tried billing Medicaid for a pair of post operative...
  29. K

    Residential Treatment and DCS Contracts

    I work for a mental health facility that has a contract with DCS as a residential treatment facility. We have a building for Level 2 and Level 3 patients. If they are in the state's custody, Level 3 clients' services are only billed to DCS. If they have private insurance, Level 3 client's...
  30. M

    Observation Codes - Medicaid

    Hello, I am hoping I can get some feedback regarding the coding and billing of Hospital Observation codes for Medicaid patients. According to the HFS Handbook for Practitioners (Observation Section A-220.4) - - "Payment will not be allowed for...
  31. B

    Need modifier

    Hi Here I am getting wrestle to fix the below mentioned claims... Now I am frequently getting denials with the CPT H0023 as “missing modifier” from Medicaid insurance. I am new to see this HCPCS code, please give me your suggestion on this
  32. J

    Medicaid not covering full $166 medicare deductible.-Is anyone else

    Is anyone else having issues billing medicaid for the full $166 deductible? New York medicaid is telling me they wont pay for deductible amounts over $150. I'm telling them Medicare's new deductible is $166, they don't know what I'm talking about and insisted the charges are invalid. It's like...
  33. J

    Medicaid not covering full $166 medicare deductible.

    Is anyone else having issues billing medicaid for the full $166 deductible? New York medicaid is telling me they wont pay for deductible amounts over $150. I'm telling them Medicare's new deductible is $166, they don't know what I'm talking about and insisted the charges are invalid. It's...
  34. D

    Insurance Verification/ Medicare & Medicaid

    Part of my new position aside from coding is demo and insurance verification. For verifying Medicare and Medicaid aside from replacement policies. Is there a main website for Medicare and Medicaid to verify coverage with out having to get into separate state sites? If anyone has any info I would...
  35. N

    IL medicare xover claims

    Recently our office has experienced claims NOT crossing over from IL Medicare to IL Medicaid. Has anybody else been seeing this happening?
  36. P

    Medicaid FFS - Nevada - 51/59 modifiers

    I bill for an OB and am trying to bill 58552 with 57282. These two codes do allow a modifier. Medicaid keeps denying for incorrect modifier. We tried 51 and 59 on the 57282. Any thoughts or is anyone else having this issue with NV Medicaid?
  37. C

    Is the Q0 modifier required for OP Medicaid Patient getting an AICD?

    I am curious if the Q0(zero) modifier is required to be added to CPT 33249 for patient undergoing a OP procedure for implantation of an Automatic Implantable Cardiac Defibrillator primary prevention. I know thi sis required for Medicare. I am unsure is this applies to Medicaid. Any help would...
  38. L

    NC Medicaid help please?

    We have an ENT dr that does procedures in our facility (ASC), we are having an issue when he does a T&A (42820) or Tympanostomy (69436) along with any 30802,30930, or 30140... We get paid by commercial carriers however NC Medicaid doesnt pay but for the primary procedure. I am thinking this is...
  39. T

    Medicaid-Patient's primary

    Patient's primary insurance paid for 99242 consultation except $25 copay. Patient's secondary ins Medicaid denied cpt 99242 as non covered by plan. Can we bill the patient for the $25 or do we have to adjust it off?
  40. M

    Medicaid denials per announcement 976

    We are having a problem with Medicaid denying secondary claims per CMS announcement 976 stating that "history of ..." diagnosis codes are not acceptable as primary diagnosis codes. In these cases Medicare has paid the claim with a hx code but Medicaid is denying. I am not sure how to fix them -...
  41. H

    Will Medicaid pay if Medicare denies in NC?

    I am having trouble finding the answer to this question. We have a patient who only has Medicare part A primary and Medicaid secondary. If part A doesn't apply to us, can we file Medicaid and expect payment? If so, would you file the claim as primary or secondary with the information of...
  42. I

    GC Modifier- we are getting denials

    Hello, we are getting denials from Medicaid when billing codes 99215, 99213 and 99214 with modifier GC when the services were provided by a resident under the supervision of a teaching physician. We are sending the claims with the teaching physician Medicaid NPI number. When we called Medicaid...
  43. J

    No fault won't pay driver was drinking

    OK I have a patient that was driving drunk when they were injured in a motor vehicle accident. Under NYS no fault, their insurance company is not required to pay. I billed them anyway and course they denied payment. This patient has straight Medicaid, will Medicaid pay for these office...
  44. D

    99420-HD Illinois Medicaid

    We are receiving denials from Illinois Medicaid for postpartum depression screen. We have instruction from Illinois Medicaid to report 99420 with HD modifier under the child's RIN. Since ICD-10 we are receiving denials and find no code for postpartum depression screen. Previously we were able to...
  45. J

    64493 dx coding for Medicaid MI UHC

    Medicaid MI UHC, Having trouble getting these paid for MMB, they keep saying dx issue, can anybody please help if you are getting these pd is Michigan ????
  46. S

    Billing Psychotherapy and Evaluation to Medicaid

    Hello, Medicaid plans are not paying psych codes such as 90871. I was told that these plans will only pay H codes. (eg H2019). Has anyone else ran into this issue? Unfortunately I cannot find much reading material on billing these codes. Thanks in advance for any advise you may have.
  47. S

    80301 and 80302 bundled?

    Has anyone seen any information on these codes being bundled? We are billing to some of our Medicaid plans and 80302 pays but 80301 denies stating CCI incidental to or part of primary procedure, CMS medicaid NCCI unbundling? Just looking for any insight into this. Thank you. We use an...