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Wiki 99495 and 99213

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susanock

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9
Location
Bloomfield, Kentucky
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Can I bill with both of these CPT's on claim with modifer 25 on 99213? Also will commerical plans pay for 99495? Thanks
 
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We have the same question. We have looked every where and cant find anything that says you can not bill the two together. We are currently testing it... UHC is denying it but they are denying both codes. One code denies for duplicate and the other for time frame exceeded. When we have called the reps cant find a legitimate reason for denial and send it back for re-processing... we are still waiting for the outcome.

Medicare on the other hand is paying for both codes. Our concern is Medicare will pay this and then down the road they will decide it shouldn't have been paid and take it back. We are seeing this more and more lately.
 
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Bill at the end of the 30 days after discharge. Can be billed only once in the 30 days following discharge (cannot bill again if readmitted), and can only be billed by one provider per patient. If your provider is the pcp, and not the admitting/discharging physician, make sure the a/d physician is not providing these services and billing for them.
 
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