Wiki Multiple 92950 - Same group, different providers

[lmgillespie01]

We had 2 units of 92950 on the same day. The first unit was paid. The second unit was denied because it was a different provider, same group.
How can we rebill to get the second unit paid?

 

[SharonCollachi]

It wasn't denied because it was a different provider. Different providers of the same specialty in the same group are treated as one person.

If it was two different doctors during the same encounter, then you bill for only one unit (only one provider gets to bill for CPR for one encounter, no matter how many people do CPR).

If it was more than one encounter, then the MUE is 3 (last time I looked), and you can appeal with medical records.

 

[lmgillespie01]

It wasn't denied because it was a different provider. Different providers of the same specialty in the same group are treated as one person.

If it was two different doctors during the same encounter, then you bill for only one unit (only one provider gets to bill for CPR for one encounter, no matter how many people do CPR).

If it was more than one encounter, then the MUE is 3 (last time I looked), and you can appeal with medical records.

It was more than one encounter. Yes, the MUE is still 3. We'll appeal.

Thank you so much. I really appreciate the response.