You can bill his copay because it is his secondary, I can tell you now the most they will pay is between $9.80 and 12.44. However I would drop the claim to paper and send the primary eob showing the patient responsibility.Patient's primary insurance paid for 99242 consultation except $25 copay. Patient's secondary ins Medicaid denied cpt 99242 as non covered by plan. Can we bill the patient for the $25 or do we have to adjust it off?
I'm thinking its best to use regular E&M codes especially if Medicare or Medicaid is one of the patients coverages (its also the safest as pretty much every payer accepts 99201-99215). I'm not surprised using regular E&M vs Consult doesn't have as much effect on the rate. Once Medicare stopped reimbursing Consultation codes they also raised the RVU on regular E&M to account for some of the loss.Another provider I worked for in the past had this issue when Medicare & Medicaid plans began not covering consult codes. When we ran into this scenario (primary allows consult codes / secondary/tertiary does not allow consult codes) The provider would bill a regular E/M code on patients in this scenario. This decision was made after contract rates were evaluated for payers in question for the various consult codes versus E/M codes.
This is no a recommendation of what you should do...just sharing what a provider did that I used to work
Are you sure medicaid even pays? The rate is so low usually the primary payer has paid more than medicaid would owe, causing the remainder to be a write off.You can bill his copay because it is his secondary, I can tell you now the most they will pay is between $9.80 and 12.44. However I would drop the claim to paper and send the primary eob showing the patient responsibility.