I have a scenerio where we billed Medicare a IUD placement and Supply in which they do not pay. The pt also has Medicaid and I sent the bill over to Medicaid with the Medicare eob and they are stating we are not authorized to bill. The claims rep could not help me at all. This situation is new to me so if anyone can tell me what I am doing wrong I would appreciate it. This is in MA.
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Wiki billing Medicaid - I have a scenerio
- Thread starter monalisa
- Start date
jgf-CPC
Guest
medicaid
In the state of Georgia, Medicaid will not pay anything that is denied by Medicare no matter what code it is. Could this pertain to MA also?
In the state of Georgia, Medicaid will not pay anything that is denied by Medicare no matter what code it is. Could this pertain to MA also?
kumeena
True Blue
I do not know about the payment part. But we bill with V25.1 58300 and J7300 (paraguard IUD)
barbacasec
Networker
We are in NH and Medicaid pays for the 58301 (insert) and J7302 (iud mirena) we have to put the NDC number on the J code for them to pay it but we haven't had any trouble getting it paid, and they usually pick up what medicare wont pay as long as it is a covered service by Medicaid.
-Casey CPC, CFPC,CGSC,COBGC
-Casey CPC, CFPC,CGSC,COBGC
Medicaid DOES pay for J7300 and 58300 in NY. This is true for ptn with just regular Medicaid and for Ptn w/ medicaid choice/plan like Fidelis Healthcaare NY. Since Fidelis is a Catholic org. they do NOT pay for controceptives and Medicaid picks up the balance. HOWEVER, I also have a problem on one of my medicare ptns and Medicaid denied the claim. still have no solution to that. sorry.
Is impossible to obtain some kind of reinbursment from medicare & medicare for the iud because:
1)medicare does not cover any srvc related to contraceptive devices.
2)medicaid only will cover the iud thru the pharmacy benefits or medical supplier & not by the medical provider (unless the pt plan is a medicaid hmo)
1)medicare does not cover any srvc related to contraceptive devices.
2)medicaid only will cover the iud thru the pharmacy benefits or medical supplier & not by the medical provider (unless the pt plan is a medicaid hmo)
don't miss 57800 & a4550 revenue
we learned from a drug rep that SC medicaid will pay for "sounding" of the uterus(57800) and surgical tray(a4550) as well as insertion(58300), product(j7300 or j7302) and a pregnancy test(81025) if patient is menstrating at the time of her appointment. Sorry I don't have any specifics on Medicare/Medicaid. We bill all 5 codes for all insurance companies but often have to w/o 57800 for some of the commercial insurance companies.
we learned from a drug rep that SC medicaid will pay for "sounding" of the uterus(57800) and surgical tray(a4550) as well as insertion(58300), product(j7300 or j7302) and a pregnancy test(81025) if patient is menstrating at the time of her appointment. Sorry I don't have any specifics on Medicare/Medicaid. We bill all 5 codes for all insurance companies but often have to w/o 57800 for some of the commercial insurance companies.
I was just wondering can anyone please point me in the direction of these type of codes (a4550). We never before billed for it and I was wondering where can I find a discription of what exactly is this code (besides "surgical tray) and I am sure there is some sort of a book that I don't know of.
Thanks
the procd codes will be find in the cpt book (insertion & removal 58300 & 58301 using diag v25.1 & removal v25.42), also contact the medical supplier tht provide the iud ie Mirena which they have a website with all the info related to their product
www.mirenasupport.com.:cool:
www.mirenasupport.com.:cool:
TrinaKnight123
New
is your patient on family planning take charge program? We are able to get medicaid to pay on the J7302 and the 58300, but have had a patient that was take charge only and we got the denial of we are not authorized to do this service. We are with medicaid, we are not registered with the Take Charge program, which is done separately. Trina
Bonny
In WA state, we are not contracted to accept Take Charge so if that's the patien'ts plan, we refer them to Family Planning. If they hae any other Medicaid coupon we get reimbursed for the insertion, 58300, the method, J7300 or J7302, a pregnancy test, 81025 and and E&M code, if approp. with modifier 25. They will not pay the surgical tray & I've never tried the uterine sound code.
One reason you may not be reimbursed is based on your provider type and yur Core Provider Agreement with Medicaid. Check with your provider rep about that. Also, I've had private payers try to deny the IUD as they only cover prescription dispensed at the pharmacy. I have won every appeal based on this method can only be inserted by the provider and not by a pharmacy.
Good luck!
In WA state, we are not contracted to accept Take Charge so if that's the patien'ts plan, we refer them to Family Planning. If they hae any other Medicaid coupon we get reimbursed for the insertion, 58300, the method, J7300 or J7302, a pregnancy test, 81025 and and E&M code, if approp. with modifier 25. They will not pay the surgical tray & I've never tried the uterine sound code.
One reason you may not be reimbursed is based on your provider type and yur Core Provider Agreement with Medicaid. Check with your provider rep about that. Also, I've had private payers try to deny the IUD as they only cover prescription dispensed at the pharmacy. I have won every appeal based on this method can only be inserted by the provider and not by a pharmacy.
Good luck!