Wiki Claims not being paid for Ultrasound (CPT 76700 and 93975)

[patdow]

I have been billing CPT code 76700 with CPT code 93975 for ultrasounds and using only the 59 modifier. Recently, Blue Cross Blue Shield and Humana have stopped paying for these. Is this because I don't use modifier 26? Or perhaps we need separate diagnosis codes for each CPT code? Can someone please advise. Thank you.

 

[astephens]

93975 and 76700

I am in New Mexico and we are having the same problem, insurance will deny requesting medical records and eventually deny the claim for lack of medical necessity.

 

[reawagner]

using modifier 26? Professional components?

Assuming your billing for professional component correct? Are you billing with Correct diagnosis to each cpt code?

 

[brittneyxnicole]

76700 is usually bundled in 93975. If there is medical necessity to do both (in my experience this is not common), then a -XU (or -59) could be applied to 76700.

 

[brittneyxnicole]

Also, if you are billing for the physician then yes, you need a -26 modifier attached.