Wiki FQHC Billing G0101

[mcarter1017]

Hi,

I was just thrown into the world of FQHC, without much training and I'm needing some help please! Medicare is denying G0101 billed with the qualifier G0467 for CO97 ~ benefit included in procedure that's already been adjudicated. Am i missing a modifier?? Any help is appreciated ~I'm so confused!

Thank you much!!

 

[cjtown]

G0101 Medicare Requirements

G0101 is reimbursed by Medicare every two years, unless the patient is considered high risk. I have attached the MLN Matters for these services in a FQHC setting.

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/Downloads/MM8927.pdf.

Hope this helps.
Carla

 

[mcarter1017]

Thanks ~ So am I to understand that G0101 does not need to be billed with the qualifying codes ~ G0466, G0467?

 

[cjtown]

No,
For FQHCs billing under the PPS, G0101 and Q0091 are qualifying visits when billed with FQHC payment HCPCS codes G0466 or G0467. 3rd paragraph last sentence in the MM8927.

So you would bill the two codes for the service and the visit codes at the same time. Since you were getting a CO97, they may have already paid you for the visit code on that specific date of service. Did you happen to have a M code preceding the CO97?

 

[mcarter1017]

I went back and pulled the EOB ~ It does have M remark codes :

M80 ~ Not covered when performed during same session as previously processed service for pt
M15 ~ separately billed services have been bundles as they are components of sane visit

 

[cjtown]

M15 CO97 billed service or benefit is not separately payable by the health plan. Sounds like this service is not deemed high risk for the patient or has been billed more than once in a two year period. therefore not payable and that reflects the M80 Not covered when performed during the same session/date as a previously processed service for the patient.

 

[mcarter1017]

Thank you for all your help!