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EMEDNY (NEW YORK MEDICAID) not covering modifier 25

Akulo

Expert
Messages
405
Location
Bronx, NY
So I'm having trouble with New York Medicaid not covering the second CPT code.

Ex 99203-25 (paid)
11100 (denied)

or 11100 (paid)
99203-25 (denied)

They're denying what ever is coded second. I called them and they told me since 07/2016 they're no longer paying for procedures billed with office visit or office visit billed with procedure. I asked them to direct me where I could find this in writing and they directed me somewhere that doesn't say it anywhere unless there's something wrong with my eyes. https://www.health.ny.gov/health_care/medicaid/program/update/2016/jul16_mu.pdf

They're actually recouping all the claims after 07/2016 because of this.

Is anyone aware in detail of this going on? I'm not getting anywhere with Medicaid Reps.

Thanks.
 
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