Wiki GY on S codes

[hsmith67]

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

 

[SharonCollachi]

The problem with the GY modifier is that it has to go on a code that Medicare considers excluded. Invalid does not equal excluded.

Look at the regular CPT codes for infusion, here is a place to start: https://www.nhia.org/wp-content/upl...oding-Reference-for-Home-Infusion-Therapy.pdf