Wiki Group Visits

[sgilbert029]

Hello,
I wanted to reach out to see if anyone else is having this issue or might have the answer to help me. The family practice that I bill for has started doing Group Nutrition visits for patients in a certain program. We are billing out the 98961 but Medicare has been rejecting it stating that "the benefit for this service is included in the payment/ allowance for another procedure /service that has already been adjusted". We are unsure if there is a HCPCS code that Medicare wants or would pay. We bill these out separately so we are confused as to what other service it would be included in. Any help on this is appreciated.

 

[CBLENNIE]

I'm not certain why Medicare would be rejecting this code because the benefit for the service is included in another service which as already allowed, because Medicare does not cover this code. Per Encoder Pro:


Per CMS Transmittal dated 02/26/2007 R1188CP these codes in this range 98960-98962 are not covered for Medicare this transmittal specifically states the following:

If the services your provider is rendering to these patients meets the definition of Medical Nutritional Therapy (MNT) there are 2 codes for billing these services a group therapy, 97804 & G0271. However, benefits for MNT are limited to treatment of patients with Diabetes, renal disease or have had a kidney transplant in the past 36 months.

Here is the quick reference chart on MNT coverage under Medicare. There is a specific NCD for MNT 180.1 that you may want to review as well as it is more comprehensive than this quick reference chart.

Hopefully this information will help you figure out what is covered by Medicare in terms of nutritional therapy/education and what the requirements are for it to be covered and how to bill it.

 

[sgilbert029]

I'm not certain why Medicare would be rejecting this code because the benefit for the service is included in another service which as already allowed, because Medicare does not cover this code. Per Encoder Pro:
View attachment 6587

Per CMS Transmittal dated 02/26/2007 R1188CP these codes in this range 98960-98962 are not covered for Medicare this transmittal specifically states the following:
View attachment 6588
If the services your provider is rendering to these patients meets the definition of Medical Nutritional Therapy (MNT) there are 2 codes for billing these services a group therapy, 97804 & G0271. However, benefits for MNT are limited to treatment of patients with Diabetes, renal disease or have had a kidney transplant in the past 36 months.

Here is the quick reference chart on MNT coverage under Medicare. There is a specific NCD for MNT 180.1 that you may want to review as well as it is more comprehensive than this quick reference chart.

Hopefully this information will help you figure out what is covered by Medicare in terms of nutritional therapy/education and what the requirements are for it to be covered and how to bill it.

Thank you so much! I appreciate all your help!

 

[CBLENNIE]

YW