Wiki Need a Modifier for 99497 when I have other services as well

tbaker808

Guest
Messages
2
Best answers
0
I can claim 99214:25 along with 99497 and get paid for both. But I sent a claim to WPS Medicare for a patient as follows
99214:25
99497 (Advanced Care Planning)
96372:59 (injection)
J3420 (B-12)
Medicare did not pay 99497, saying it was combined with the injection. So they paid the 99214, 96372, & J3420. When I called WPS, the rep said the 99497 needed a modifier in order to get paid. Modifier 59 does not work for the 99497; I tried that too. Do they want an XU modifier?
I've been accustomed, when I have multiple distinct services, to leave one procedure/service "un-modified" and then put the 59 on the next (less costly) procedure(s).
 
EM code

Try modifier 25 on 99497 since it in of itself is an EM code, and to distinguish it from the injection fee, you can use it. I have done two mod 25's on claims before...
 
25 can be used twice, but make sure the documentation clearly supports each individual service.
 
Top