Billing S9500 rejected by Medicare clearinghouse

latoshac

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I am billing home IV infusion for a patient with Medicare primary and BCBS supplement Plan F. Medicare does not cover home infusion services (S9500) but the patient's supplemental plan will pay for home infusion services. Our problem is we can't even get the S9500 code to pass the clearinghouse so we can get a denial to forward to the secondary plan. I have added the GY modifier which states that this is not a medicare covered service. Anyone have a suggestion how we can get these charges through the medicare e-rejections?
 

CodingKing

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Medicare will not accept S codes even if its not covered. I'm shocked a Medicare supplement would accept codes that are not accepted by Medicare. Aren't there regular CPT codes you can bill such as 99601/99602
 
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thomas7331

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Medicare does cover home infusion under certain circumstances. Skilled home health services for Medicare patients are generally paid by the part A contractor and are billed on a UB form using revenue codes. S9500 is a code specific to commercial payers - you won't be able to use that code, or bill that service on a professional claim form, for a Medicare patient.
 

latoshac

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99601/99602 are for home visits for infusion, which would not apply since we are only providing the medications and supplies for self-infusion by the patient.
 

kcarlyle

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We bill A4223 GY instead of S9500 GY for the Medicare denial from the part B contractor (not DME) for the PR-204 denial when the secondary will cover as the primary payer.
 
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