GY on S codes

hsmith67

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Greenville, NC
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I am billing S0164 and S9379 to Medicare Texas (Novitas). Patient previously had BCBS primary and they paid $57+/day combined for the two codes. Patient has daily home infusions so $57+ = over $1,700/month in reimbursement from BCBS. Now that Medicare is primary they are rejecting on receipt even with a GY modifier. Medicare advised they have discretion to consider a code valid or invalid and S codes are considered invalid codes and therefore the GY modifier accomplishes nothing. I'm not wanting to walk away from $1,700+ a month in reimbursement from BCBS just because Medicare considers these codes "invalid" and reject upon receipt.

Any suggestion/guidance is greatly appreciated!

Hunter Smith, CPC
 
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