Wiki 97530 and 92526

[lindsey.pritchard@gmail.com]

I'm working in a pediatric OT/ST/ABA clinic. We have some OT patients who do not have a particular diagnosis for feeding difficulties, but our OTs work on Oral function with them, as well as other therapeutic activities. They have tried to code this as 1 unit of 92526 and 3 units of 97530. Several insurance payers are paying the 92526 as it is a higher level, but not paying 97530. They have listed this with a modifier 59 to indicate they are different procedures, but some insurers won't accept that. Are we billing incorrectly? Do I need a different modifier? 51? Any advice?

 

[AmandaBriggs]

Is there a signed order for the oral function therapeutic activities? What is the medical necessity for these activities? Just because your therapist is providing the service doesn't necessarily mean that the service is separately billable.

 

[lindsey.pritchard@gmail.com]

Is there a signed order for the oral function therapeutic activities? What is the medical necessity for these activities? Just because your therapist is providing the service doesn't necessarily mean that the service is separately billable.

It's in his Plan of Care, but not ordered by an MD