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Hi,
We billed CPT codes 99213-25 and 97597-RT to Ambetter. The claim was processed with payment for 97597, but 99213-25 was denied with the remark “This procedure is not paid separately.”
Has anyone experienced this issue with Ambetter? Were you able to successfully appeal, and if so, what documentation was required?
Additionally, we billed diagnosis codes L60.0, B35.3, and L74.513. I have noticed that some diagnosis codes require additional documentation. Is it advisable to remove those diagnosis codes or adjust the diagnosis pointer settings? Will changing the pointers impact claim processing or payment?
Any guidance would be appreciated.
We billed CPT codes 99213-25 and 97597-RT to Ambetter. The claim was processed with payment for 97597, but 99213-25 was denied with the remark “This procedure is not paid separately.”
Has anyone experienced this issue with Ambetter? Were you able to successfully appeal, and if so, what documentation was required?
Additionally, we billed diagnosis codes L60.0, B35.3, and L74.513. I have noticed that some diagnosis codes require additional documentation. Is it advisable to remove those diagnosis codes or adjust the diagnosis pointer settings? Will changing the pointers impact claim processing or payment?
Any guidance would be appreciated.