Wiki 96372-59 denial

[Gator]

I am not sure which forum to put this on so I will start here.
We billed to HUMANA Medicare 99214-25
96372-59
J1885-JZ
G0008
90653
Humana is denying 96372-59 for "the procedure code was not correct for the services or date of service billed." I ran the above codes and modifiers thru McKesson Clear Claim Connection and all codes were allowed. I also ran it thru without a -59 mod & all codes were still allowed. I think I have looked at it too much. What am I not seeing?

 

[mbhuey]

The -25 mod should unbundle the 96372, the 59 is not needed. It's possible payer may not pay 96372, there is not a supporting DX or the want G0463 in place of 99214?!? Just throwing out scenarios. Hard to know what payers will and will not pay these days. Take care.