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Wiki ACP 99497/ AWV/ E-M code

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aksilvis

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I have a provider that tends to see pts for their AWV, ACP and often a seperate E/M code on the same visit. Lately I am being told that insurance will not cover the ACP 99497 portion of the visit. We are billing it with a 33 modifier (which is how we have always billed it) I am at a complete loss. I've researched everything I can think of. Is there anyone with any experience in this area that can help me out?
 
Have you checked the individual payer policies for the ones denying this combination of services? It could be a coverage policy but may be a reimbursement policy or a published claim edit. The payer may also offer a claim check tool where you can input your claims data and it will return results indicating covered or non-covered with some kind of rationale for why it's not covered. When you're really lucky, they'll link right to the policy that drives the decision.
 
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