Wiki Modifier when billing CPT 99214 and CPT 96127

[kmorga]

Hi, I work for a family care clinic, no mental health providers, and we received a denial from Molina Medicaid stating a modifier is required when billing CPT's 99214 and 96127 together. I have looked all over and cannot find anything. Does anyone know anything about billing these codes together?
Thanks,

 

[sls314]

Hi, I work for a family care clinic, no mental health providers, and we received a denial from Molina Medicaid stating a modifier is required when billing CPT's 99214 and 96127 together. I have looked all over and cannot find anything. Does anyone know anything about billing these codes together?
Thanks,

What state? Medicaid billing can vary widely by state, so we'd need to know the state to help research what it might be.

Also, are you billing the same way for traditional Medicaid and other Medicaid plans in the same state? If so, are you also having trouble with those claims or is it just Molina Medicaid only that's a problem?

(That might help give us a clue for researching whether it's a Medicaid billing rule for that state, or whether it is Molina-specific.)

 

[kmorga]

Sorry for not giving all the information in my first post. I am in Washington State. We are billing the same way for state Medicaid and all of the states Medicaid MCO's.
Unfortunately, we joined an ACO about 9 months ago, and we are not being given much feedback on our denials, so I come by them randomly. I do know that all of the state Medicaid MCO's follow the State Medicaid billing guidelines. Thank you again for any help you can offer.