Wiki cpt 99395/Medicaid denied

[Jetzabel Nassiry]

This is a 22 year old established Pt. with special needs; came into our office last year for a WCC, coded the visit as 99395 but it was denied by Medicaid arguing the code only covers ages 18-20, i looked and keep looking for appropriate code, does it even exist? Please anyone help. Pt. schedule to come in again on Wednesday for same check-up.

 

[espressoguy]

This is the appropriate code, but does your state Medicaid even cover wellness visits for adults? I think what they are saying is that Medicaid only covers this up to age 20 even though the code you are using says this is appropriate for 18-39.

You mentioned this is a special needs patient and there is a modifier that is used in this case. Unfortunately, I can't remember what it is. Of course your state Medicaid rules may differ from mine.

Edited to add: I asked my coworkers who do primary care and for WA state Medicaid we use the HCPCS code T1023-HI with ICD-9 V79.3-V79.9. Again your state Medicaid rules may be different.

 

[Jetzabel Nassiry]

Thanks, Ok so now i know there is no other mysterious code to use for this pt's age, i will look further and see if our State covers it or not.