CPT codes 99408 & 96127

aksilvis

New
Messages
1
Location
Nampa, ID
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0
I am getting denial after denial for CPT codes 99408 & 96127. It doesn't matter if it's billed with a wellness code or an E/M code. I have denials from just about all insurances stating "bundled" Does anyone know of a way to get these codes paid? My provider swears that they should be able to be reimbursed separately.
 

csperoni

True Blue
Messages
893
Location
Selden
Best answers
3
99408 has an N status for Medicare, so it will never be covered. Medicare does have G0396 screening code which is separately payable. Remember that the 15-30 minutes needs to be separate from any time spent on the E/M and would not normally be included in the E/M. For private carriers, you would need to check their policy, but it seems many carriers do not pay separately for this. Some may require -25 or -59/-XU.
These were the top 2 google searches:

For 96127, Medicare does allow this code $5.05 and I don't see it as a CCI edit for E/M. It does bundle column 2 for Medicare AWE G0438-G0439. Again, private carrier rules vary and it is best to refer to their policy, and may require modifiers.
 
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