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Wiki Medicare and cpt code 96372

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Restevez1989

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Saint Jo, TX
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Hi, I have noticed Medicare is only paying cpt code 96372 for one unit. I have billed the office visit with modifier 25 along with multiple injections but they only pay for one administration fee. Any advice would be great! Thanks!

:D
 
Are you billing the 96372 showing a multiple quantity, or are you putting them on individual line items for each one?
 
it could be several issues.. first you are using a very general and unspecified diagnosis for a specific treatment. Second was this delivered IM or as a joint injection.
 
This is true. The doctors are very quick to pick a code with the least specificity. I have been working with them to improve this and to add more documentation.

The injections were given IM.
 
The documentation is very vague and doesn't specify much besides a fall. I will query the provider for clarification.

I do have amazing news, I just got a claim from Medicare that paid both administration fees with the modifier XS!

Thank you so much! You are a super star :)
 
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