Humana Denials

nat0786

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I have noticed and increase in denials for Humana. The most common is do to inappropriate or missing modifier.
Most common codes I bill out are 98941; 97110 and 97012. What modifiers do your practices use?
 

haraml7

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Sometimes the insurance companies are very vague when it comes to answers to coding. They cannot really give us advice on how to code. So, in this case, I would look at all of my other codes on my claim form that involve any of the above-listed codes and go from there. Do any other codes on the claim need a modifier? If these are your only codes on the claim form I am not really sure what kind of modifier they are referencing to?
If you could give me a little more information I may be able to help a little more.
 
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I have noticed and increase in denials for Humana. The most common is do to inappropriate or missing modifier.
Most common codes I bill out are 98941; 97110 and 97012. What modifiers do your practices use?
I have been having this issue to. If you figure it out will you please let me know. Thanks!
 
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I have been having this issue to. If you figure it out will you please let me know. Thanks!
The NCCI says: Medicare covers chiropractic manipulative treatment (CMT) of five spinal regions. Physical medicine and rehabilitation services described by CPT codes 97112, 97124 and 97140 are not separately reportable when performed in a spinal region undergoing CMT. If these physical medicine and rehabilitation services are performed in a different region than CMT and the provider is eligible to report physical medicine and rehabilitation codes under the Medicare program, the provider may report CMT and the above codes using modifier 59 or XS.

Also, as someone said, PT codes now need a GP modifier, as well.
 
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I am having issues with Humana as well. The patient is over 65, but is still working and has her insurance through her spouse. Humana is applying the 98941 to her deductible, but the 97012 and 97010 are denied for missing/wrong modifier. I have added the GP, but still denied, even when if I catch it before it before claims are sent or as a corrected claim.
Any more ideas??
 
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Just off the top of my head...if this is a Medicare Replacement, then PT codes may not be covered per MC guidelines. MC only pays for 98940-98942 with mod AT. All other codes will deny.
 
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