95941/G0453 for UHC


Royse City, TX
Best answers
UHC is denying 95941 across the board. They have continued to tell us that we should refer to the Replacement Code Policy and utilize G0453. They have even updated their policy as of 01/01/2019 stating that 95941 will not be reimbursable when billed in the facility setting, which is how it is always billed.

The problem is, is that G0453 is for the monitoring of a single patient, whereas we monitor three patients simultaneously. Unless I am reading the code description incorrectly, we cannot bill G0453. Some of the other billing team here thinks we can bill G0453 as long as it's only billed for a single block of time per patient and no over-lapping with other patients. Which would mean if I am monitoring 3 patients from 1300 to 1500, I can bill, hypothetically, G0453 x 3 to patient A for 1300-1345, G0453 x 3 to patient B for 1345-1430, and G0453 x 2 to patient C for 1430-1500. I don't believe this is correct, as the description states that attention must be directed towards a single patient, which we don't do.

In essence, if I am reading the code correctly, we cannot bill for the professional interpretation of the IONM at all because UHC won't allow the code that we need, although they added it to their policy on 09/01/2018.

I really need help getting this figured out if any one has any suggestions.