How to bill a 97001 to Medicare

apanda24

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Does anyone have any specific information on how to bill a 97001 to MCR? I can't get any of my 97001's paid by Medicare. I have reviewed the LCD requirements for Texas and am billing accordingly. I am billing with the correct G-code with the correct Impairment Modifier. However, Medicare will not process my claim. I keep getting a denial code of MA130-Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable.

The attachment below reflect a print screen of how the claim is billed.


Any assistance would be GREATLY appreciated!

Amanda Aguirre, CMOM
Texas Orthopedic & Physical Therapy
 

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  • Medicare 97001 Claim.pdf
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mhstrauss

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Does anyone have any specific information on how to bill a 97001 to MCR? I can't get any of my 97001's paid by Medicare. I have reviewed the LCD requirements for Texas and am billing accordingly. I am billing with the correct G-code with the correct Impairment Modifier. However, Medicare will not process my claim. I keep getting a denial code of MA130-Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable.

The attachment below reflect a print screen of how the claim is billed.


Any assistance would be GREATLY appreciated!

Amanda Aguirre, CMOM
Texas Orthopedic & Physical Therapy

It's been awhile since I've looked over the "impairment" g-codes, but at first glance, I'm thinking you need more than the 1 that is on the claim. The G8978 is for current status--you one for goal status also. Let me do a little digging, and I'll have a better answer.
 
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