Denials billing 99417

[kathleeng]

Is anyone else receiving denials on 99417 to commercial payers that don't follow Medicare guidelines, for invalid diagnosis? They pay the E&M for the DX but not the prolonged care code, although the DX is valid and matches documentation.

 

[JulieP]

We have had this issue recently with United Healthcare. Apparently they don't recognize this code and instead require G2212 to be billed in it's place.

 

[TThivierge]

Hello
The list of prolonged service listed on pgs. 43& 45 in the CPT manual yr. 2021. CPT 99417 cannot be used by hospital and heard payers do not like this CPT code. We use CPT 99354 for face to face however provider must add minutes on record stating it is prolonged treatment, just like if crisis or consultation treatment must tell on the documentation. And for phone or video add modifier 95 with CPT 99358 if prolonged phone or video session
I hope this data helps you
Lady T

 

[kathleeng]

Hello
The list of prolonged service listed on pgs. 43& 45 in the CPT manual yr. 2021. CPT 99417 cannot be used by hospital and heard payers do not like this CPT code. We use CPT 99354 for face to face however provider must add minutes on record stating it is prolonged treatment, just like if crisis or consultation treatment must tell on the documentation. And for phone or video add modifier 95 with CPT 99358 if prolonged phone or video session
I hope this data helps you
Lady T

Thank you. We are billing office, not hospital based.

 

[kathleeng]

We have had this issue recently with United Healthcare. Apparently they don't recognize this code and instead require G2212 to be billed in it's place.

Yes, we have seen that with UHC also.