Lynn877
New
I do billing for a pathology lab, and we are receiving denials from Medicare that state "M97-Pmt included in facility reimbursement". When I call Medicare to ask about this, each time I'm told that the patient was receiving outpatient services at a facility (usually a local hospital) for a specific date range that our date of service happens to fall into. Our charges are completely separate from the outpatient services, and Medicare recommends I file a corrected claim with a modifier to support that our charges are separate. I'm unclear on what modifier would be best to use for this as I have no idea what kind of outpatient services the patient is receiving, just that the specimens we processed did not come from that facility. Looking at the basic definitions, XP or XE either one look correct, but digging deeper, both look to only be useful for separate charges performed under a single NPI, which is not the case here. Any recommendations are welcome...