Wiki Mcaid still denying emg codes

[seanny]

Although Medicare now recognizes 95885 & 95886 as add-on codes to the primary NCS procedure, Medicaid is still denying EMG's as primary payor. This is despite them paying on EMG's secondary to Medicare.

Medicaid has changed the denial code from "mammography code/bundled with primary procedure" to "claim lacks documentation for adjudication."

I will appeal the new denials, just as I have appealed about 5 per week, but Medicaid takes way too long to process the redetermination, and it takes way too long to get through on the phone.

Has anyone had any luck getting EMG's paid by Medicaid (we are in NC)? I am running out of patience with the appeals process and am hoping for an easier/quicker way. They just keep coming up with excuses.

Thanks

 

[rmelissa]

Hey, I'm up here in CT, and I can tell you that we have issues with Medicaid and add on codes. They're looking for a modifier 59, dispite the fact that it will then pay at 50% vs the 100% an add on code should get.
I understand your frustration, try mod. 59 on the EMG. Hope that helps.

 

[seanny]

Thanks Melissa. I actually just spoke with Mcaid after holding for an hour. They are aware of the incorrect edit and are "working to correct it, ...not told when." Apparently, an adjustment (appeal) will get it paid before they make the correction.

FYI: Medicaid will not accept an ERA from your billing system included in the appeal; it will get denied. They require the RA in the original format downloaded from their 'webtool' or website.