Wiki BCBS denial

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lashonfren

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Spring Lake, NC
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We have recently been getting denials from BCBS for these specific codes: 99396 mod 25
90471, 90715. They are paying for the 90471, but not for the 99396 (CPE). Has anyone else been getting this denial, or are we adding the modifier to the wrong code? Please help!!!
 
Is this a Medicare advantage plan? They won't cover the 99396 or the 90715. If it is a non Medicare plan all charges should be covered w/ the -25 added to the 99396.
 
Are they using a clinical editing software tool? I work for a payer and we just deactivated that edit so that both the E&M and 90471 will be paid together. The clinical editing software tool we use was causing the denial. Appeal your claim - find out why.
 
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