Wiki 95874

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aruiz1231@yahoo.com

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Hello, I'm trying to bill 95874 for a botox procedure but this particular code is not being paid, does anyone know if we have to use the TC modifier in order for the code to get paid? If there is anyone out there who can help, I would welcome any feedback. Thanks!
 
aruiz1231@yahoo.com said:
Hello, I'm trying to bill 95874 for a botox procedure but this particular code is not being paid, does anyone know if we have to use the TC modifier in order for the code to get paid? If there is anyone out there who can help, I would welcome any feedback. Thanks!
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What is the denial reason? You shouldn't have to use the TC modifier, if your physician is performing these injections in his/her clinic, and owns the equipment.
 
it is being bundled into another procedure. what I code is 64644, 95874 and the botox j0585 the 95874 is not paying so do I try using a modifier since Medicaid has the TOS un der laboratory, prof component and or technical component??!! help please!
 
aruiz1231@yahoo.com said:
it is being bundled into another procedure. what I code is 64644, 95874 and the botox j0585 the 95874 is not paying so do I try using a modifier since Medicaid has the TOS un der laboratory, prof component and or technical component??!! help please!
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My opinion is that since 64644 is a new code, a lot of payers have not updated their systems to show that the add-on code (95874) should be allowed with all of the new Chemodenervation codes. We see this at the beginning of every year with any new codes that have add-on codes involved. My advice is to send a copy of the CPT book showing the page with 64644 (there is guidance on that page to use 95874 along with the chemodenervation code), and the page with 95874 (guidance there to use 95874 with 64644). Hi-lite those areas and appeal.

Hope this helps!
 
Meagan, this is great advice to the original poster. This happened to us just recently regarding a different set of codes and had to wait for our MCR carrier to update their system. It took awhile before they correctly processed the codes for payment.
 
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