Wiki e/m code and xray denied

[ajf_92@icloud.com]

Billing a 99213 with a 73560 and the insurance companies are denying the office visit and only paying for the x ray and saying it is a bundled service. is anyone else experiencing this? if so what insurance companies are you seeing this with.
in my practice I am seeing it with Humana and Medicare.

 

[TThivierge]

Billing a 99213 with a 73560 and the insurance companies are denying the office visit and only paying for the x ray and saying it is a bundled service. is anyone else experiencing this? if so what insurance companies are you seeing this with.
in my practice I am seeing it with Humana and Medicare.

ajf
What is the dx code and did use modifier 25 on CPT 99213?
Lady T

 

[amyjph]

1

Wiki Thread 'DENIALS FOR BUNDLING OF EVALUATION AND MANAGEMENT CODES WITH XRAY CODES'

Jul 8, 2025

WE ARE RECEIVING DENIALS STATING THAT EVALUATION AND MANAGEMENT CODES BUNDLE WITH X-RAY COES. WE HAVE NOT EXPERIENCED THIS UNTIL RECENTLY. DOES THIS SOUND CORRECT THAT THEY BUNDLE? I HAVE NOT HEARD ANYTHING ABOUT THIS

• 19moonr@gmail.com
• Replies: 4
• Forum: Orthopaedics

 

[amyjph]

https://provider.humana.com/coverage-claims/processing-edits/claim-processing-edits-search?PolicyID=8664

https://provider.humana.com/coverage-claims/processing-edits/claim-processing-edits-search?PolicyID=4881

https://provider.humana.com/coverage-claims/processing-edits/claim-processing-edits-search?PolicyID=8923

Is the provider's specialty radiology? Is your practice billing for the global X-Ray and own the equipment?

https://www.cms.gov/files/document/09-chapter9-ncci-medicare-policy-manual-2026-final.pdf

Are they looking for a 25, does the documentation support a 25?

 

[ajf_92@icloud.com]

I did not use a mod -25, we are not specialty radiology, we do have a Xray and mri machines in the office and our providers read the images themselves.