1. A

    2016 Medicare Tier Pricing/ Other Insurances

    I am trying to find out what insurances have decided to follow CMS and their Tier Pricing for 2016? I have spent the past few days contacting insurances, however most of them are either clueless, or just tell me that they're not making any changes "as of yet" After a nightmare in 2015 with...
  2. N

    Filing Medicare Tertiary Claims (Novitas)

    Does anyone know the secret to getting tertiary claims submitted to Medicare (especially Novitas) successfully? We cannot file them electronically through our clearinghouse. Novitas first told us they would only accept if we did send by paper but put "tertiary claim" in box 19. That worked...
  3. T


    Question is anyone having to put an NDC# on claim in order for Medicare to make a pymt?
  4. Z

    Medicare Coverage for Arterial Duplex -93925/93926

    Hi, have anyone encountered any reimbursement problem with coding Arterial Duplex? I'm having quite a challenge in regards of which diagnosis Medicare accepts. They don't accept pain codes , M79.604 /M79.605 anymore, and same for swelling codes. Has anyone experienced same problem? Need some...
  5. S

    J codes for interthecal pump refills

    Hi I am new to pain managment billing/coding. The dr I work for has a patient with pain pump (interthecal) and my question is how do you figure out the proper units to bill Example J3010 .1mg how do u convert from micrograms to milligrams? I know that just 1 unit is only paid .70 by Medicare...
  6. C

    statutory exclusion labs

    So, I have been doing some research on labs and found most labs' status indicator is X (statutory exclusion-these codes represent an item or service that is not in the statutory definition of "physicians services" for the fee schedule payment purposes. No RVU's or payment amounts are shown for...
  7. E

    Modifier 73 - screening colonoscopy

    For the facility side, if a Medicare patient presented for a screening colonoscopy which was terminated prior to sedation, would you code 45378-73 or G0121-73? I am sure for other than Medicare it would be the former, but not sure what to do for this Medicare patient. TIA Richard
  8. S

    Medicare PT Coding

    Good morning - I'm having a bit of difficulty trying to figure out just what Medicare wants when coding our PT services. I've sent 97001, 97112 (with multiple # of services) and I'm getting the CO-4 denial, which is stating that the procedure code is inconsistent with the modifier used (I...
  9. K

    Radiesse and Medicare

    I am trying to find out if Medicare will pay for the actual medication, Radiesse, and how much. They recently announced coverage for Radiesse in HIV positive patients experiencing depression as a result of lipoatrophy. The administration codes (11951-11954) are posted with allowables, but I...
  10. krburke

    How best to report bilateral 20610 to Medicare

    One of my providers has given 20610 injections in both knees. How does Medicare want to receive these codes? These are the options I came up with: 20610-RT x 1 unit 20610-LT x 1 unit OR 20610-50 x _ units? Would this be billed as 1 or 2 units? Any other modifier besides -50? I have not had...
  11. J

    Which do I bill 80101 or G0431?

    80100 and 80101 vs G0430 and G0431 I have several internal med practices that bill CPT 80100 and 80101 QW for point of care urine drug screen which are on the CLIA list. I understand that Medicare added new HCPCS code G0430 (for 80100) and G0431 (for 80101). The difference in the language is...
  12. D

    Need help!!!!

    Hi all; I posted this last week and didn't get any response. I have a question regarding Medicare patients. Is there a regulation regarding the number of mental health visits a Medicare beneficary can have per year? Does it depend on if it is a parity dx or not? Any help would be appreciated...
  13. D

    Mental Health Visits for Medicare pts.

    Hi all; I have a question regarding Medicare patients. Is there a regulation regarding the number of mental health visits a Medicare beneficary can have per year? Does it depend on if it is a parity dx or not? Any help would be appreciated. Thanks again!
  14. J

    Correct coding of purchased stress echo

    I have searched unsuccessfully looking for an answer in regard to purchased diagnostic tests for "stress scho". We have a number of practices serviced what I call the "Scan Van." The tech does the test and the reading is done by a specialist in that field. In short, the ordering physician pays...
  15. L

    Need insight on Medicare Appeal

    I am having to appeal a claim for the first time with Medicare. I am not exactly sure where to begin. Do i need to send the appeal directly to Medicare or to our FI? Any other tips would be great. Thanks
  16. L

    Medicare denying 96375

    Im getting denials from Medicare for CPT Code 96375. They are stating that it is an unbillable code. I made sure the claim had the proper Initial Code, but it still is denying. Any insight would be great. Also, i know this code is Modifier 59 exempt, but i found a claim that paid this code...
  17. J

    Medicare Capitation question

    I'm new to billing and have a few questions about Medicare Capitation. In the last 6 months I've had Medicare deny payment on 4 visits due to a capitation agreement. The Dr. is upset that we've basically let 4 patients be seen for free and he wants me to find out which patients are affected by...
  18. S

    ZOSTAVAX (shingles vaccine)

    ZOSTAVAX ("shingles vaccine) Does anyone have any information regarding Medicare guidlines for billing the new vaccine? ie; CPT, ICD etc.. and is anyone billing and GETTING PAID for those by Medicare and othr carriers? Thank you!!