Davitto62
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Can 99396 be billed with 99214? Do I need to add modifier 25 to 99214? Patient is presenting for a physical as well as follow-up on multiple issues
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Hello All,
I'm a little confused as to why the Medicare Fee Schedule doesn't have a pricing for the 99397 but there is an an RVU for it. Providers have billed a 99213 and a 99397, Some pay some don't pay/reimburse for both codes. Can someone please help and explain why this is?
And one other reason that this CPT code is not priced on the MPFS is that preventive services are billed using Level II HCPCS codes and not Level I CPT codes to Medicare.Medicare does have pricing for it but its suppressed from printing on the Medicare Physician Fee schedule. It's both status N not covered and has the not used for Medicare Pricing indicator this not reimbursable by Medicare. Many non covered medicare codes have RVU set because they may be covered by an MA plan for example. I use the RVU for commercial pricing. There is even RVU for Consultation Codes for example. Non covered service Acupuncture too. Over 140 codes fall under this concept, i attached a list of codes not accepted for Medicare which have RVU on the July file
I am having issues with billing 99214 and a wellness visit. They don't want to pay for the well visit only the 99214. Does this have anything to do with RVU's? It is for Horizon blue cross blue shield. They pay the 99213 with the well visit. I am thinking it was an RVU issue but I am not sure.