Wiki Modifier PT/XS

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lamiller

lamiller

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Murfreesboro, TN
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I have been getting denials for 45385-PT and 45380-XS from BlueCross Medicare Advantage saying they are bundled. I have done reconsiderations and appeals with no luck. I attended a Gastro Seminar a few months ago and spoke to another Gastro Office in Tennessee that was getting paid for both. I never got their input on how they were getting paid for both when we are not.

Is there anyone in TN that is getting paid by BlueCross Medicare Advantage for both 45385-PT and 45380-XS? We even tried to use 59 on 45380.
 
I'm in Michigan and I use the 59 Modifier. I do get rejections for the 2nd proc stating it's a bundled procedure but I do an appeal and I would say 90% of my claims are paid. We have tried 59 and XS Mod.(not together) and it still gets denied. Every now and then they will pay for both procedures without me having to do an appeal. I don't get it, I only can say it's so time consuming having to do this. I was told BX had a new system update and ever since they've been rejecting my claims. Oh, if it's a screening I do use PT, 59 on 45380 and it still denies. Good Luck to you.
 
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