Wiki 96127 denials

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lveburg

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Stromsburg, NE
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Nebraska Total Care denies this code every time. It does not matter what modifier we use, what other codes are with it, they will never pay. I have contacted this MCO and there isn't a billing policy. Does anyone have any luck getting this paid? The other Nebraska MCOs pay as they should.
 
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lveburg said:
Nebraska Total Care denies this code every time. It does not matter what modifier we use, what other codes are with it, they will never pay. I have contacted this MCO and there isn't a billing policy. Does anyone have any luck getting this paid? The other Nebraska MCOs pay as they should.
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What is the denial that you are receiving?
 
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lveburg said:
Sometimes it is a preventive visit: 99384, sometimes it is an office visit: 99213, sometimes there are labs, sometimes there are vaccines.
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Is it safe to assume that modifier 25 is being appended to the E/M? The situation in which you bill with labs and vaccines is curious. I would default to someone familiar with Nebraska payers. Or maybe try billing the services on separate claims? I'm sorry I can't be more helpful.
 
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