Wiki Modifier 22 - Does anyone know if medicaid

[TishCpc]

Does anyone know if medicaid and the hmo superior health will pay additional money for the modifier 22 on cpt?

 

[philipwells]

They should if you can prove it was more work. Appeal and send in the operative report showing the additional work.

 

[hopepg]

I'm not sure on the specific payers you list. I would check their provider section of their website & see if modifier 22 reimbursement policies are located anywhere. They may have a specific process for your to bill these.
Otherwise, I would pull your contract fee for the code you are billing with the modifier 22. In your appeal specifically let them know that they have paid (that is if they actually did) the contracted rate but did not consider the additional allowable for the modifier 22 usage.
If your provider documents why the modifier 22 is being appended, detail that in your appeal request. For example, if the provider documents that the case took 2 or 3 times as long as a normal __________ & goes into detail of what took the extra time -then in your appeal reference this documentation & let them know what page of the note the detail is located.