Wiki Medicare denying E&M when billed with 11055, 11056, & 11721. 25 modifier is attached

[BMWilliams]

Is anyone else seeing more denials from Medicare? The 25 modifier is attached, and the notes do show that the procedure codes were not planned. Is this something new with Medicare? If you have come across this issue, what was you way of handling the issue and were you able to get paid?? Thank you for you help.

 

[podcoder70]

Were these claims for 2021? There was an issue last year that Medicare was aware of and were to fix. The claims have to be resubmitted to get paid properly. Can you provide an example with diagnosis codes just to confirm?