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Hello,
We are billing add on codes with the appropriate primary code. Payers were reducing the add on code by 50% and citing they were applying a multiple procedure reduction to the add on code. The add on code was not billed with a 51 modifier and I appealed it.
The Payers are now reducing the primary code by 50% and paying the add on code in full and citing multiple procedure logic was applied. Medicare does not reduce the primary code- they pay the primary code and add on code at 100% of the allowed.
Does anyone know if there is something available that states they cannot reduce the allowed for the primary code billed?
Thank you
We are billing add on codes with the appropriate primary code. Payers were reducing the add on code by 50% and citing they were applying a multiple procedure reduction to the add on code. The add on code was not billed with a 51 modifier and I appealed it.
The Payers are now reducing the primary code by 50% and paying the add on code in full and citing multiple procedure logic was applied. Medicare does not reduce the primary code- they pay the primary code and add on code at 100% of the allowed.
Does anyone know if there is something available that states they cannot reduce the allowed for the primary code billed?
Thank you