Question acupuncture updates

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Lake Worth, FL
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Is anyone running into issues when billing for acupuncture to Medicare when not using a payable Dx codes? Typically we would bill Medicare with the GX modifier knowing it wouldn't be covered by Medicare but we could still bill the patient since it denied PR. Now that Medicare is covering for certain Dx codes our denials have been contractual. Any input would be appreciated. TIA
 

SharonCollachi

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Clovis, CA
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I think GA would be a more appropriate modifier. See the second bullet point under GA below.

GA Modifier:

Waiver of Liability Statement Issued as Required by Payer Policy.
  • This modifier indicates that an ABN is on file and allows the provider to bill the patient if not covered by Medicare.
  • Use of this modifier ensures that upon denial, Medicare will automatically assign the beneficiary liability.
GX Modifier:

Notice of Liability Issued, Voluntary Under Payer Policy.


  • Report this modifier only to indicate that a voluntary ABN was issued for services that are not covered.
  • Medicare will automatically reject claims that have the –GX modifier applied to any covered charges.
  • Modifier –GX can be combined with modifiers –GY and –TS (follow up service) but will be rejected if submitted with the following modifiers: EY, GA, GL, GZ, KB, QL, TQ.
  • Additional information on the –GX modifier can be found at: http://www.cms.gov/mlnmattersarticles/downloads/MM6563.pdf
 

dsokeefe

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We are having the same issue billing Medicare for acupuncture billing with both the GA and GX modifier. We have also tried billing without any modifier and the non-covered ICD10 codes still all denying M76, MA130
 

SharonCollachi

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Clovis, CA
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M76: Missing/incomplete/invalid diagnosis or condition.
MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

I'm sorry, I misunderstood. The problem is not your modifier. It is your diagnosis code, as stated by your denial code. Even if you are billing a service that will not pay, you still have to use a valid diagnosis code, because the claim cannot be processed without it.

What diagnosis codes are you using?
 
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