Wiki CPT 99496 and 99495

[vanessa58912@gmail.com]

Hi, I submitted CPT code 99496 with pos 11. However, the insurance company rejected the claim, stating invalid pos. Can anyone provide assistance? thank you so much in advance

 

[TThivierge]

Hi Vanessa
Ok this is for a patient who was INPATIENT status in which now the provider checking on them atter discharged. The provider has up to 7 days AFTER discharge to check out patient since released. The Transitonal Care Mgnt.CPT 99496 is high complex check up .Whereas CPT 99495 provider has 14 days after discharge check up on how patient doing. You can check pages 60 in The CPT manual 2024. Also documentation from provider should mention when patient inpat. status, where and for what medical problem.
I hope this data helps you
Lady T

 

[Patricia Seabolt]

I think your denial reason may be incorrect. I would call the insurance and question the denial reason to get more information. the CPT code is billable for POS 11.