Wiki G0378 CPT bundled with 96374 - Facility charge

[narashimanbpt11@gmail.com]

Hi,

I have got a denial for Aetna insurance where CPT G0378 has been denied stating the cpt is bundled with 96374 which is for facility charges, Can anyone please suggest can i use modifier 25 with G0378 and refile the claim.

Thanks

Narashiman BPT, COC, CPC

 

[thomas7331]

Infusion and drug administration charges are often considered packaged into facility observation case rates and not eligible for separate payment. If that's the case, then this is not really a denial, but it's just that the observation payment is all-inclusive, and a modifier will not get you additional payment. But you would need to review Aetna's policies and/or your provider's contract to see whether or not the claim is paid correctly. If in fact there are exceptions that would allow for a modifier override in this situation, you would need to review your documentation to see whether or not it supports the use of a modifier and then determine what the appropriate modifier would be, based on the circumstances.

 

[narashimanbpt11@gmail.com]

Thank you

Narashiman COC CPC