Wiki Medicaid Modifier for CPT 17250

[kknudsen]

Hoping someone can assist. We do a small bit of Medicaid billing here in California. We are are getting a denial for missing modifier for CPT 17250. Not sure which modifier they are asking for - AG? Any assistance would be greatly appreciated. Their webiste isnt very user friendly for find answers.

 

[EricaPhl]

Is it billed with another service? Is it in the post op from a biopsy? If post op it is 79

 

[nrood]

I would check out the Medicaid Fee schedule for California. The PA Medicaid fee schedule allows you to search the database for the code per your provider type. It will pull up all information that would be needed to know for payment purposes- what modifiers are needed and at what POS they will pay for a service. When I pull that code up under our website, it shows no modifier needed on 17250 and code will be payable under POS: 11, 22 and 49. This may be different in CA, so I would recommend checking that fee schedule for your state.
However, as stated above, other factors need to be considered as well like if it was billed with another procedure and if it was billed within a post op period, etc. to be able to pinpoint the exact issue.