Our pediatric office has been submitting 99188 with a 59 modifier for almost a year. An out of area Blue Shield plan is now telling us the modifier is not valid for the CPT. Please clairfy!!
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Wiki Correct modifier for 99188
- Thread starter gozervld@gmail.com
- Start date
SharonCollachi
Guest
Blue Shield of which state would be helpful. Looks like almost all plans are covering it, up to a certain age, and some do note that a modifier is not required.
It's a Blue plan from Illinois, the child was 15 months old at the time of visit.
SharonCollachi
Guest
Okay, looking on their webpage, under preventive care, we find this:
99188 Provided at no cost in a non-grandfathered plan. Payable with a diagnosis code in Diagnosis List 1.
Diagnosis List 1 Z00.00 Z00.01 Z00.110 Z00.111 Z00.121 Z00.129 Z0.08 Z01.10 Z01.411 Z01.419 Z02.83 Z11.1 Z11.3 Z11.4 Z11.51 Z11.7 Z12.11 Z12.12 Z12.2 Z12.31 Z12.39 Z12.4 Z12.5 Z13.0 Z13.1 Z13.220 Z13.31 Z13.32 Z13.4 Z13.41 Z13.42 Z13.5 Z13.6 Z13.820 Z23 Z30.011 Z30.012 Z30.013 Z30.014 Z30.015 Z30.016 Z30.017 Z30.018 Z30.019 Z30.02 Z30.09 Z30.40 Z30.41 Z30.42 Z30.430 Z30.431 Z30.432 Z30.433 Z30.44 Z30.45 Z30.46 Z30.49 Z30.8 Z30.9 Z32.2 Z71.41 Z71.51 Z71.6 Z71.7 Z71.82 Z71.83 Z86.32
Since there is nothing about a modifier, it may pay without one.
Here is a link to the entire policy.
99188 Provided at no cost in a non-grandfathered plan. Payable with a diagnosis code in Diagnosis List 1.
Diagnosis List 1 Z00.00 Z00.01 Z00.110 Z00.111 Z00.121 Z00.129 Z0.08 Z01.10 Z01.411 Z01.419 Z02.83 Z11.1 Z11.3 Z11.4 Z11.51 Z11.7 Z12.11 Z12.12 Z12.2 Z12.31 Z12.39 Z12.4 Z12.5 Z13.0 Z13.1 Z13.220 Z13.31 Z13.32 Z13.4 Z13.41 Z13.42 Z13.5 Z13.6 Z13.820 Z23 Z30.011 Z30.012 Z30.013 Z30.014 Z30.015 Z30.016 Z30.017 Z30.018 Z30.019 Z30.02 Z30.09 Z30.40 Z30.41 Z30.42 Z30.430 Z30.431 Z30.432 Z30.433 Z30.44 Z30.45 Z30.46 Z30.49 Z30.8 Z30.9 Z32.2 Z71.41 Z71.51 Z71.6 Z71.7 Z71.82 Z71.83 Z86.32
Since there is nothing about a modifier, it may pay without one.
Here is a link to the entire policy.
Thanks so much!! I really appreciate your help 