Wiki 99417 Medicaid Limit

[sgilbert029]

Hello everyone,

I am running into an issue with one of my claims with Medicaid where they have denied the code 99417 based on it maxing out its unit limit. I called and they were unable to give me the limit number of how much I could bill and I have looked everywhere online and can not find anything. I was wondering if anyone has run into the same problem with this code?

Thank you.

 

[amyjph]

How much more time are you trying to bill in addition to a 99205 or 15? How many 15 minute units? The CMS MUE is 4.

 

[sgilbert029]

We billed out 2 units and when we called the max limit had been met.

How much more time are you trying to bill in addition to a 99205 or 15? How many 15 minute units? The CMS MUE is 4.

We billed out two units but when we called they had told us that the max limit had been met. We also billed out four other dates of service for the patient in the same month totaling six units of the 99417.

 

[sls314]

Hello everyone,

I am running into an issue with one of my claims with Medicaid where they have denied the code 99417 based on it maxing out its unit limit. I called and they were unable to give me the limit number of how much I could bill and I have looked everywhere online and can not find anything. I was wondering if anyone has run into the same problem with this code?

Thank you.

Have you looked in CHAMPS Medicaid Code Rate and Reference Tool?

Michigan Medicaid has information about frequency limits and other coverage parameters in CHAMPS.

https://www.michigan.gov/mdhhs/doing-business/providers/providers/billingreimbursement/physicians-practitioners-medical-clinics

https://www.michigan.gov/-/media/Project/Websites/mdhhs/Medicaid-Provider-Assets/CHAMPS/CHAMPS-FAQ.pdf

 

[sgilbert029]

Thank you everyone for your help, I was about to find out that it is limited to six per month.