Horizon BCBS denying 76942

[Athlete2023]

We billed 99213 with 25 mod + 76942 with 59 mod + 20551 with 51 mod + 76882 + J0702. All the codes were paid except for 76942 which was denied as CO-97 (benefit for the service included in the payment/allowance for another service/procedure already been adjudicated). I sent an appeal explaining 76942 (ultrasound) was done for proper needle placement (20551) and 76882 was done for diagnosing the problem but the appeal was upheld. How do we make Horizon BCBS pay for 76942 also. Is there a specific modifier we need to use. Thanks.

 

[Athlete2023]

Hi, any update on this?

 

[jkyles]

Hi there, have you thoroughly reviewed Horizon's policies to make sure they don't automatically bundle ultrasounds into another service? Remember that policies can be based on the place of service as well as the procedure.

 

[Athlete2023]

Can you please give me some more insights on this as to whether or not Horizon will pay in these cases.