Wiki EMEDNY (NEW YORK MEDICAID) not covering modifier 25

JesseL

Expert
Messages
404
Location
Bronx, NY
Best answers
0
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.
 
Top