Wiki Fee Schedule

amanda19791

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Fountain Inn, SC
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My office is having a difficult time getting CPT 19260 paid due the code not on the SC Medicaid fee schedule. See the comment I am getting from AR department:
I just checked SC Medicaid fee schedule - the 20601 NOR the code Amanda changed it to (the 19260) are on the SC Medicaid fee schedule. 19260 was deleted on 010120 and replaced with the 21601 per encoder pro.

Does anyone have any suggestions how my office billed this? I thought about appealing with explanation of the cpt code not on the fee schedule.
 
I am not understanding what you are trying to say. If a code is not on a fee schedule, it likely won't get paid. If you're saying you need a good excuse for missing a timely filing deadline, you won't lose by appealing, only by doing nothing.
 
My office is having a difficult time getting CPT 19260 paid due the code not on the SC Medicaid fee schedule. See the comment I am getting from AR department:
I just checked SC Medicaid fee schedule - the 20601 NOR the code Amanda changed it to (the 19260) are on the SC Medicaid fee schedule. 19260 was deleted on 010120 and replaced with the 21601 per encoder pro.

Does anyone have any suggestions how my office billed this? I thought about appealing with explanation of the cpt code not on the fee schedule.
Amanda, did you ever get this resolved? I am running into the same issue. We billed 21601 initially as that was the new code for 2020 but its not on the fee schedule. I reached out to SC Medicaid about it but haven't had much luck. I am actually billing this to Select Health Medicaid but they of course go by the SC Medicaid fee schedule. I did look back at an older base physicians fee schedule from Nov 2019 that luckily i had saved and the original code 19260 was on that fee schedule. I'm about at my timely filing limit to get this paid so I was wondering if you had any luck?
 
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