Medicaid plans denying cath codes

stone6401

Networker
Messages
28
Location
Ocala, FL
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Hi all!

Lately I've noticed that the PUP, Freedom, and UHC Medicaid plans have been denying my cath codes (ie: 93458-26) as "not eligible charge" or "not Medicare allowed".

I heard somewhere that they don't want the -26 modifier. Does anyone have any info on this? Thanks!
 

jewlz0879

True Blue
Messages
823
Location
Richardson, TX
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I always bill our caths with a 26 bc we do them in the hospital so we can't bill the global code. Is the cath being done with a stent or PTCA? If so, then you need to append modifier - 59 to the heart cath.
 

stone6401

Networker
Messages
28
Location
Ocala, FL
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Thanks for your reply.

No it's not a -59 issue, they are denying caths by themselves. That's why I don't want to remove the -26 b/c how would they know that it's not global since it's done at the hospital.
 
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