1. A

    Studying for Family Practice Certification

    I am interested in sitting for the CFPC credential, but where I currently work does not bill Medicare. I was looking at the overview on what the test consists of and knowing the rules and regulations of Medicare billing is listed. I am unsure if just reading over the guidelines would be...
  2. F

    Billing for services by a Dietician

    I am in need of help on billing for a dieticians services, we have a new NP in our practice and he she as requested consults form our Dietician. Can the services provided by the Dietician be billed to Medicare even though she does not have a provider number? I am looking for instruction on how...
  3. K

    Question on billing outpatient - We are certified

    We are certified as a Rehab Agency by Medicare and bill Medicare on a UB. When billing outpatient PT, OT, ST in a private residence, do we enter our business name AND the patient's address (since it is the service address) in FL1?
  4. D

    How to code Medicare Preop evaluation

    What code should I use for a Preop evaluation for a patient that is going for cataract surgery and has Medicare for insurance? I use as first diagnosis Z01.818 and was denied. Do I have to use the Z code as a second diagnosis and code the reason of the surgery first?
  5. 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?
  6. C

    Routine Laboratories

    Hello, I was really hoping someone can help me obtain the ICD-10 diagnosis code for routine labs? We have several Medicare patients who have had there labs denied because Medicare does not cover routine. What if the patients are healthy and the physician is screening for something that does not...
  7. P

    New VNG code for Audiologists

    I work for an Audiology practice in Southern California and we are billing with the new VNG code 92537 which replaces 92543 (4) units. This change was recommended by the American Speech Language Association and the American Academy of Otolaryngology Head and Neck Surgery. I verified in the 2016...
  8. K

    Gastroenterology - I have a claim that Medicare denied procedure

    I have a claim that Medicare denied procedure 97605 when billed together with 20102 stating invalid modifier billed with 97605. The procedures were billed as 20102-78-GC and 97605-59-78-GC. I verified in NCCI and these modifiers are appropriate. Does Medicare not want the modifier 78 on...
  9. P

    PQRI requirements for Neurology

    Does anyone know the PQRI requirements specifically for Neurology to qualify for Medicare reimbursement?
  10. J

    ABN/modifiers/moderate sedation

    I understand the following to be a question to and response from the AMA about time in moderate sedation: _______________________________________________________________________________________________________________________ Question: Is it appropriate to report the moderate (conscious)...
  11. L

    Billing Medicare as secondary

    We are Urgent Care and have an Ancillary contract with Cigna,UHC, and Aetna requiring us to bill S9083 at a flat rate regardless of what was done. I have a patient that is Medicare secondary. Cigna applied charges to pt deductible now I need to bill Medicare but they do not take the S codes...
  12. Y

    Medicare Mammogram Diagnosis Z12.31 or Z12.39

    I just received a notice that the diagnosis we used for a routine annual mammogram Z12.31 is not billable under Medicare. What diagnosis code should be used?
  13. M

    Ear swab culture

    We have always used 87070 when sending an ear swab for aerobic bacterial culture...starting this month the lab we use is changing this code to 87186 stating Medicare requires we use it. However Medicare is denying the code due to "not medically necessary", has anyone else received this? Doesn't...
  14. C

    hospital inpatient treated in physician office

    One of our physicians treated a patient in the office while the patient was an admitted inpatient in a hospital. Medicare denied our Part B claim for inconsistent place of service - CO5 as the hospital also submitted a claim for the same date of service. I was told by a Medicare rep that a Part...
  15. T

    Medicare Denial of 88305 when billed with an unrelated MOHS

    We are a dermatology practice with a doctor that specializes in MOHS (and is a histophathologist). We also employ ARNP's who will occasionally do excisions of skin cancers on the same day a MOHS is performed, which results in an 88305 charge. The pathology is read by our doctor-the...
  16. T

    Medicare Denial of 88305

    We are a dermatology office whose doctor is a certified dermatopathologist as well. He can perform MOHS. We have come across a new issue with Medicare when billing MOHS and a separate pathology on the same day. Here is an example: Patient comes in and has MOHS done on the arm by the doctor. The...
  17. T

    Colonoscopy -know this has probably

    I know this has probably come up several times, but here goes again. A pt came in Aug 2011 for colon w/biopsy 45380 at the age of 62 with UHC insurance and dx for diverticulitis. In 2008 he also had 45385 with UHC for dx blood in stool. He is now 67 and has Medicare and has no symptoms. The...
  18. H

    Incdient II billing and Physical therapy

    I have a question regarding Incident II billing with physical therapy visits for Medicare. My current practice will be merging with another group who has their own PT office. Their PTs are not credentialed with Medicare however the practice that owns them is. The physicians want to bill every PT...
  19. R

    arthroscopy 29877

    Can somebody please help me out on and ICD 10 issue I am having with Medicare. Whenever I bill out cpt code 29877 w/ chrondromalacia dx/ M22.41 or M22.42, Medicare denies. Any suggestions? I have searched LCD w/ no luck at all. Thanks
  20. N

    lmft seeing medicare patient

    Does any one have feedback on how to go about the following situation... A severe chronic patient has changed insurance and now has medicare. i know that LMFT can not bill medicare. The patient is in no way stable enough to change providers. is there a way to handle this? the patient is willing...
  21. J

    Advanced Care Planning Services - Medicare

    Medicare has approved coverage for Advance Care Planning Services for 2016. I know the codes are 99497 and add on code +99498. Has anyone heard what the RVU's and reimbursement rates are? Looking to maximize our revenue by using ACP codes in addition to our usual code set or using prolonged...
  22. H


    does anyone know if medicare is holding back money until they have a clear fee schedule done??
  23. C

    NC Tracks(NC Medicaid) and assistant to surgery Modifier denial

    Good Morning, Just wondering if anyone else is having trouble getting paid for assistant to surgery for PA's. We are filing with CPT code 37225- 80. Medicare is paying as primary and then medicaid denies stating CPT/modifier combo is invalid. When the AR girls call NC Tracks all they will tell...
  24. D

    History of Colonic Polyps and E/M Codes

    Hello our physician at our practice used an E/M code of 99397 for a Dx code Z89010, this is a Medicare patient is this coding correct? Will Medicare pay?
  25. A

    Medicare In patient only list

    Does anyone have a direct link to the Medicare In-patient only list for 2016?
  26. Y

    HCPCS code modifiers

    Medicare requires modifier w/A4352, A4402-This is new. What modifier should we use?
  27. T

    Would you use mod 25 or 59

    When reporting codes 99204 and 96103, would you use modifier -25 or -59? for non-medicare and medicare cases...
  28. E

    Consult with POS ER for Medicare

    I have been coding ER visit codes 99281-5 for the crosswalk for Medicare Consults when the POS is the ER and not crosswalking to OP visit codes new or established for Hospitalist and Orthopaedic consults ;I use those when the POS is Obsrv. Can anyone tell me if I am correct to bill the ER codes...
  29. H

    93280 26

    dx is V45.01 medicare having a hard time getting paid any thoughts would help and its dos 7/9/15 thanks a bunch
  30. 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 -...
  31. D

    Billing DME to Medicare Without Medicare Contract

    After 26 years in working for physicians' offices, I started working for a DME business late last summer. We just became CHAP accredited and are filling out a Medicare Provider application. My question is - If we see a patient who has Medicare primary, can we bill Medicare DMERC (ie., before...
  32. J

    Billing vaccines for a fqhc

    Our clinic is a FQHC and I'm trying to find out how other clinics bill Medicare for influenza and pneumoccal vaccines. If a patient is seen for an office visit the provider will code a routine office visit (i.e. 99213) along with the codes for the vaccine and its administration code (90670...
  33. T

    Medicare - government funded

    Can we bill Medicare for the 22 modifier, asking for more money since they are government funded?
  34. 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...
  35. P

    How to bill when one Provider in practice opts out of Medicare

    I need some advice on how I would bill Medicare for the Nurse Practitioners who still participate in Medicare but the Doctor has opted out of Medicare? And all three are in the same group practice that the Doctor owns. I would appreciate any information I can get...
  36. D

    Preventative Services and Gastro

    I need some advice one of our physicians keeps coding patients visits with a 99387 (preventative medicine) with use of ICD-10 codes: Z86.010 personal history of polyps, or Z12.11 Encounter screening for malignant neoplasm of colon. My issue is some of our patients are Medicare patients and as...
  37. D

    Medicare ABN Question

    Can anyone tell me if a Medicare ABN must be signed on the date of service? We give home hemoccult tests that the patient takes home and then brings back or mails back to our office. Can an ABN be signed on the date the test is given to the patient? Or must it be signed on the day the test is...
  38. N

    "Not payable due to coordination of benefits"

    Please help me to understand this. We bill Medicare and many patients have secondary. My question is below. Example: BlueCross EOB says "This amount is not payable due to coordination of benefits with the member's other carrier. " In this case, can we bill patients (Medicare allowed...
  39. D

    Cardiac Resynchronization Therapy for treatment of Heart Failure

    I am needing some help with Cardiology practice billing CPT 33249 and 33225 for POS 22 to Medicare Part B J5. The claims are being denied as not medically necessary, decision based on NCD policy online. The policy I found is 20.4 NCD for Implantable Automatic Defibrillators. This policy does not...
  40. H

    Multiple Medicare Denials for Medical Necessity

    I apologize ahead of time for my ignorance, I am still new to coding/billing and have learned on the job through trial and error. I received 3 pages of denials from Medicare for " these are non-covered services because this is not deemed a "medical necessity" by the payer". But the codes used...
  41. M

    Medicare denial for 88305 and 88342

    I got denial for 88305 and 88342 from Medicare. According to remittance advice modifier(S) was missing. Do I need to apply modifier 59 to 88305? I am confused I did not know that any modifier needed for those codes.
  42. E

    Toxicology codes

    I'm confused on the drug screen codes. Medicare deleted g6030-g6058 but they are still in hcpcs book.
  43. P


    Medicare is wanting a Therapy modifier on the 97610. This is performed in the office. Anyone know which modifier it should be?
  44. R

    MUE of 1 but a bililateral procedure

    If Medicare has a MUE of 1 but the CPT can be billed bilaterally, can you bill this with a 50 modifier and get paid for both sides?
  45. R

    Medicare and CPT 64561

    Medicare is denying the 2nd 64561 when billed like this? 64561-LT 64561-RT Do I need to add a modifier XS to the 2nd line item? Send reports? The MUE is 1 for this CPT. Any feedback would be appreciated. Thank you!
  46. J

    G6021 for EMR needs 2 codes

    Can you please help me how to enter the charges in the HCFA form if we have to use those 2 codes like 45378 and G6021 to indicate this is and EMR colonoscopy for medicare patient, how would you enter the $ amount, as we know we cannot bill CPT45390. Medicare will not pay new codes for DOS in...
  47. E

    medicare auditing for payor

    When coding charts for Medicare audits: If a pcp is coding cancer as current and the specialist is saying the patient is in remission can we change the pcp code to hx of cancer?
  48. B

    Radiopharm Reimbursement

    We have just started having problems getting our Radiopharm's paid, even with Invoice. They've all gone to Q2 level and are now denying. They (Medicare) will not tell us why, specifically. We've done everything they've asked. Is anyone else having this problem? Any input would be greatly...
  49. T

    CPT code S0199 help

    Does anybody know anything about the S0199. Medically induced abortion by oral ingestion of medication. This code says all associated services and supplies included (except drug). The Aetna HMO/NAMM says not covered my Medicare so they denied the services. I don't know if there is anything we...
  50. O

    Anyone ever used the CR modifier?! (Catastrophe/disaster-related)

    Hey, y'all. Has anyone ever seen or used this 'CR' modifier?! I'm in Texas and even with our tornado and hurricane disasters, I've never seen this one before. I can find CMS info but would like to hear from someone who has actually used this and what was the result? Catastrophe/disaster...