Question CEEG-Special EEGS> Palmetto GBA

Launie75

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When reading the breakdown of special EEGs, the new Continous EEGS have replaced the old 95951, 95953. I understand it is now comprised of the Technical and Professional Component and can also include the set-up/breakdown/education if applicable.

We are doing the 2-12hrs and do provide and bill the following codes as they apply to each of our patients. 95700, 95713, 95718. So far Palmetto GBA has processed the 95700 & 95718 but denied the 95713. I am not sure why as codes 95713 and 95718 should not require modifiers as the actual wording of it being a technical or professional code is already built into it. So it doesn't make sense that maybe it might require a TC modifier. Has anyone billed Medicare for this and came across the same issue? So far the only carrier that has processed for us is BCBS Anthem and they processed our claim w/these 3 codes without an issue. Can anyone assist further on this or provide more insight?

Thank you
 
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I am seeing the same thing here (AL). When I look up the fee schedule for the 95713 on cms.gov under Medicare is states "This code is contractor priced under the Physician Fee Schedule. Please contact your local Medicare Contractor for payment amounts."

So I go to Palmetto GBA's site and pull the fee schedule and it appears as though it is not priced/allowed. https://www.palmettogba.com/palmetto/fees_front.nsf/fee_main?OpenForm#JJB

Maybe I am looking at something wrong, but I also input my claim (95718 x 1 and 95713 x 1) into Find-A-Code and no issues found with claim. Medicare has only denied the 95713 line with CO-252.
Any guidance is greatly appreciated.

Thanks!
 
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Do you provide both the technical and the professional service, and what is the site of service? Also, what were all of the denial codes on the 95713?
Our office provides both the technical and professional sides of the service in the office setting and we received a CO-252 denial on the 95713.
 
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