Wiki Amerigroup-well child visits

[jbittner261]

We have started seeing our well visit codes (i.e. 99396) not being reimbursed by Amerigroup. They are paying for for the vaccine administration with the SE modifier but are denying the well visit with the explanation: this procedure is considered CCI incidental to or part of the primary procedure.

Any ideas??? Thanks so much!

 

[MarcusM]

CPT 99396 is not a well "child" visit so it may be bouncing due to age related issues.
New Patient:
99384 - adolescent (age 12-17)
99385 - 18-39 years
99386 - 40-64 years
99387 - 65 years and older
Established Patient:
99394 - adolescent (12-17)
99395 - 18-39 years
99396 - 40-64 years
99397 - 65 years and older