y4zhill
New
Hi all -
I am trying to find guidance for the billing and reimbursement of critical care codes, for CCS MediCal.
June 1st, the reporting codes changed from Z0100-Z0108 to the use of CPT E/M codes.
Modifiers -HA and -TG are to be used on codes 99291 & 99292.
By nature of the CCS parameters, these cases are for children and it happens that most of our cases are complex.
This necessitates our use of both modifiers.
The interesting part is when billed with -HA and/or -TG, we are receiving less payment as opposed to a higher payment (which is expected).
Does anyone have any insight on CCS reimbursement for CC codes 99291 & 99292?
Thanks in advance ~
I am trying to find guidance for the billing and reimbursement of critical care codes, for CCS MediCal.
June 1st, the reporting codes changed from Z0100-Z0108 to the use of CPT E/M codes.
Modifiers -HA and -TG are to be used on codes 99291 & 99292.
By nature of the CCS parameters, these cases are for children and it happens that most of our cases are complex.
This necessitates our use of both modifiers.
- -HA = child or adolescent program
- -TG = complex/high tech level of care
The interesting part is when billed with -HA and/or -TG, we are receiving less payment as opposed to a higher payment (which is expected).
- using modifiers -HA and -TG, we are seeing $296.01
- with just modifier -TG, we are seeing $120.38
- with no modifier, we are seeing $413.52
Does anyone have any insight on CCS reimbursement for CC codes 99291 & 99292?
Thanks in advance ~