Wiki 99495 not paid

[enya1998@gmail.com]

We are struggling to bill 99495 and 99496.
Days after discharge in which a face-to-face visit is required, 14 days for CPT 99495 and 7 days for CPT 99496 also it is required to have MDM
we are following 7days and 14days rule but it was not paid often from most insurance while Humana got payment well.
anybody advised me???
thanks!!!

 

[lgardner]

there are other requirements to bill 99495 or 99496:
patient must have been an inpatient at a hospital or SNF.
1 contact within 2 days of discharge
a med reconcilliation
MDM must meet moderate (99495) or high (99496) based on the conditions related to the hospital visit.
these codes can only be billed once every 30 days.

ALSO, not all insurances pay for TCMs. this may be the issue.
you might want to check your contracts with other providers.