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cpt 90715 no ABN

trose45116

Expert
Messages
305
Location
cincinnati
Best answers
0
Can we bill patients that have mediare and no ABN was received for the DTAP immunization??? Its been a while since I have done this. I thought you were not able to but just need a refresher if you can or not.
 

Evelyn Kim

Guru
Local Chapter Officer
Messages
195
Location
San Antonio, TX
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0
The only way I know of to bill a Medicare pt with no ABN on file is if the service is statutiorly not covered by MC. No ABN is needed in that case.
 

trose45116

Expert
Messages
305
Location
cincinnati
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0
ok so does that mean i can bill the patients for cpt 90715??? i have done surgery the last 5 years and have lost some of my knowledge with doing e/m coding. im slowing getting everything together with physician coding and billing.
 

kvangoor

Guru
Messages
231
Location
Grand Rapids, MI
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0
Yes, since Medicare part B never covers these (IMM's for prophylactic reasons) you can bill the patient. I would suggest that they contact their part D carrier (covers drugs and meds) and try to get reimbursed for this.
 

barbsalim

Guest
Messages
7
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0
Hep B is covered also, but that is it. I get confused by Medicare terminology but I understand that if you don't get an ABN then the patient is not liable for the service and you basically eat it. I also get from the Medicare terminology that if you don't get an ABN and provide a service you know they don't cover they consider it fraud. Do I have this right or wrong? I am very new to medical billing.
 

lara1388

New
Messages
1
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0
ABNs for possibly non covered Medicare charges.

It is my understanding, that if the service is not considered by Medicare, no fee schedule for CPT, then you do not need the ABN. It is only when there is a possible Medical Necessity consideration. Is that correct?
 
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