96127 and e/m on same date of service

[kathleenl]

Good Morning,

We are now getting denials from Emblem stating that when we bill for and e/m and 96127 for place of service 22, that the 96127 is included in the payment to the hospital. Has anyone come across this? The e/m is billed with a 25 as there is documentation to support both.

Any help or guidance is appreciated.

Thank you

Kathleen

 

[thomas7331]

That is correct, under the Medicare fee schedule, 96127 is designated as a 'technical component only' code, so if performed in a facility, the only payment would be to the hospital. There would be no reimbursement to the provider from payers that follow this fee schedule since there is no professional component.