Wiki Co-96

[jinitshah712@gmail.com]

Hi,

We have a few claims who denied payment because of reason code CO-96 (Non covered charges ) from Primary as well as Secondary insurance. Can we bill this to patient?

Please advise.

Jay

 

[mitchellde]

This will depend on the payer. If it is Medicare you must have obtained an ABN prior to the procedure and used a GA modifier when the claim was originally submitted. Other payers may require some similar form of a waiver prior to the procedure. If the EOB indicates do not bill patient then of course you cannot.

 

[jinitshah712@gmail.com]

This will depend on the payer. If it is Medicare you must have obtained an ABN prior to the procedure and used a GA modifier when the claim was originally submitted. Other payers may require some similar form of a waiver prior to the procedure. If the EOB indicates do not bill patient then of course you cannot.

Thank you.