Wiki Billing Medicare for 93571

[nancy.anselmo@ccrheart.com]

Hi, I am having trouble getting Medicare to pay 93571 (fractional flow reserve)
92982 LC 22
93458 26
99223 25
93571 LC all w/dx of 414.00 what am I doing wrong? Thanks Nancy

 

[scorrado]

You need to add 26 modifier to 93571. Hope this helps!

 

[sslater]

i was thinking i read somewhere you couldn't charge for the 93571-26 when you actually do an intervention to the vessel... that it was included in that.. but i'm still looking to see where i saw that... has anyone else saw that??

Thanks!

 

[dimmitta]

93571 & Medicare

We had originally billed these with a 26 modifier and a LD/LC/RC and were getting denied for invalid/missing modifier. We took the LD/LC/RC off and resubmitted and then received payment.

My advice would be to bill with a 26 modifier, and leave off the vessel modifier.

Hope this helps! Good luck!