medicare billing

  1. T

    Wiki What are considered Medicare b Auxiliary Personnel for welcome to Medicare physical and risk assessment

    Hi Folx, We are a HIV/LGBTQ+ integrated care clinic who is partially funded by grants. We have received a grant that focuses on people living with HIV who are becoming eligible for Medicare b. The grant specifically focuses on the Welcome to Medicare physical and risk assessment. The grant...
  2. B

    Wiki G0101 Denied with Preventive Code

    Hi all, I'm hoping to get some clarification on this. We are unsure if we are supposed to bill a patient the fee for G0101 if Medicare is denying due to it not being after the 24 months when billed with a preventive code. Example: We billed 99397 with G0101. Medicare denied G code and patient...
  3. R

    Wiki Guidance

    I am being asked to bill out one way to commercial insurances and then another to Medicare/Medicaid patients. I am under the impression that is not compliant..... example would be that the pt is having pain injections and has commercial insurance, they want me to just bill for the injection and...
  4. G

    Wiki Medicare is not paying 76937-26 for 93503

    I work with Palmetto and Noridian. I cannot find any literature for why Medicare is stating that 93503 is not a valid primary procedure code for 76937-26. They pay when we also bill 36620 or 36625, so does anyone have any insight for how we can get the ultrasound guidance paid for just the 93503...
  5. E

    Wiki Billing Radiopharmaceuticals under Medicare

    We routinely bill nuclear stress tests (78542) along with TC-99m (A9502). Several months ago, Medicare began denying code A9502 saying they need the paper invoice for the drug on file, which seemed egregious. We called Medicare, who said to include the name of the drug, the dosage, and the...
  6. N

    Wiki Medicare GYN Exam- G0101

    Hello, I was asked by one of our physicians to explain in more detail what is all included within a G0101- Breast and Pelvic Exam. For starters, our physicians see quite a few Medicare patients for breast and pelvic exams and up to this point have been billing the G0101 only but also ordering...
  7. Karajag

    Wiki Annual wellness visits w/Commercial ins secondary

    I'm looking for some direction on billing OBGYN annual visits. We have a number of patients that have Medicare primary and Commercial ins as secondary. There is some confusion as to whether we should be billing (for example) CPT 99397 to Medicare, which denies, and then it goes to the...
  8. J

    Wiki Medicare/Medicaid and MIH Programs

    I have a client that is looking to get credentialed with Medicare and Medicaid so that when her grant funding runs out for her MIH program she can bill them instead. I have looked online for some resources and am not finding much. Anyone out there have any experience in MIH billing Medicare...
  9. Y

    Wiki When to drop to PR when secondary payer processed to PR?

    I'm relatively new to Medical billing. I have a Medicare crossover claim here where they processed $25.94 to PR coinsurance but then Aetna secondary processed paid the $25.94 and put an additional $40 to PR copay. Do I bill the difference between $40 and $25.94 to the patient or is this an...
  10. K

    Wiki Billing Denied AWV to secondary commerical insurance?

    If a patient's annual wellness visit (G0439) is denied by Medicare because the patient has come in too soon and Medicare puts it to patient responsibility, should you bill it to their commercial secondary given that this is a code that only Medicare uses and covers? This is what they are doing...
  11. C

    Wiki Billing for Outpatient Physical/Occupational/Speech therapies in the home Medicare

    I am the biller for an outpatient PT/OT/SLP clinic that bills on a CMS-1500 with POS 11 Office. We have been receiving referrals for "in home" therapy for Medicare patients. We are not a home health agency and these referrals are not for home health. Does anyone know if I can bill for therapy...
  12. T

    Wiki Billing Medicare Wellness with office visit

    I work for a group of family practice providers. One has asked me if he could charge a subsequent Medicare wellness visit (G0439) with a NEW patient office visit (99204) for the same encounter. Commercial payers will let me charge an office visit with a NEW patient wellness visit, BUT ONLY IF...
  13. B

    Wiki LCPC billing under LCSW to Medicare

    I have an LCPC who would like to bill under an LCSW in IL to Medicare for psychotherapy services. I don't think this is allowed, but I cannot locate the information online. Can anyone help?
  14. D

    Wiki DME Coding/Reimbursement - A7020 and LCD L33795

    Hello! I'm looking for some insight from anyone with experience billing A7020 to Medicare for mechanical in-exsufflation devices ... the LCD is quite vague regarding accessories/supplies, but I am wondering if anyone has experienced difficulties or limitations billing A7020 for replacement...
  15. D

    Wiki DME Coding/Reimbursement - A7020

    Hello! Anyone with experience billing A7020 to Medicare for mechanical in-exsufflation devices ... the LCD is quite vague regarding accessories/supplies, but I am wondering if anyone has experienced difficulties/limitations billing A7020 for replacement circuits? If anyone with a DME-specialty...
  16. C

    Wiki Obesity Preventative Counseling

    We are billing G0447 to medicare in place of the standard 99202 code. Medicare is stating we need a modifier but we can't figure out which one. We have tried 33 and got denied already. We use modifier 25 for the 99212 code already. What modifier can we use to get reimbursement?
  17. S

    Wiki 51705 limits with Medicare?

    Does anyone know if Medicare has limits on how many times they'll pay for 51705 within a year? We're an urgent care and have a patient whose catheter is supposed to be replaced once a month, but he comes in sometimes once a week to have it replaced.
  18. A

    Wiki Billing OP Services IP for 72 Hour Rule

    Hello all, I am a new coder and trying to find answers for myself and our billing department. I understand that for Medicare patients who are rendered services such as x-rays and labs in outpatient setting then admitted inpatient within DRG window, that those services are bundled with...
  19. G

    Wiki DME Billing to Medicare-HELP!!!!!!

    Hi! I'm getting continuous rejections from Medicare for DME products. For example, I've billied L4361(Walking Boot) with and without mod NU, RT/LT and without a modifier but Medicare denies the claim saying "procedure code is inconsistent with modifier used or a required modifier is missing". I...
  20. carelitz

    Wiki ICD Implant (33249) and Q0 Modifier use

    I am trying to learn and understand the use of the Q0 modifier with ICD implant when billed to Medicare. From what I understand so far, the use of this modifier is to indicate to Medicare that the patient has the potential for sudden cardiac death. So that when certain Dx are used we need to...