- Emmaus, PA
- Best answers
I just had a conversation with Magnacare (a NY, NJ plan) They paid one claim for 99213 with no modifier at $100 as the allowed amount. The next claim was billed 99213 with a 25 Mod due to another code also being billed with E&M. They told me the allowed amount when 99213 is billed with a 25 mod is $38.50. HOW is the correct or LEGAL????? The plans are EXACTLY the same benefits....how can they allow less then even MEDICAID if you use a modifier? They didn't pay anything on the second line, and the allowed amount for that line was a whopping $4.60! That is just highway robbery. Can someone please tell me how they can get away with that???