Humana Denial

astumler98

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Is anyone having trouble with Humana not paying office visits, even with a mod 25 attached? These are all being denied in our office and bundled with lab services or vaccines. Does anyone have any thoughts are how to correct?
 
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Are you appending modifier 25 to E/M codes reported on the same date as vaccine administration codes (90460-90461, 90471-90474)? There are CCI bundling edits for vaccine administration codes with problem-oriented and preventive E/M services. Not sure about denial of E/M with labs. Hope that helps.
 

jh1991

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jh1991

Not just OVs but other codes. I have one claim seeing a hospice patient for non hospice treatment (Humana Medicare Advantage). Filed with Medicare 1st then with Humana for co-insurance. Medicare said Humana should pay but they keep refusing, telling me to file with Medicare. Have sent all information and a letter. Same reply.
 
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