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Wiki Need help with cpt 94664

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shaanah

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A claim was sent into insurance 99202 and 94664. Claim was bundled and only the 94664 was paid. Above the section for the pulmonary treatment in the CPT it states that if an E&M is also performed it should be billed "in addition to" the 94664.
The explanation I received from the insurance company is that a modifier -25 is needed to bill according to global guidelines. I have not found any NCCI edits for this yet and I cannot determine why this would bundle. Could someone direct me to documentation so that I can provide it to my provider explaining clearly why these treatments are not separately billable?

Thanks
:confused:
 
Hello,
It is advisable to append modifier-25 to the separately identifiable E and M visits, though it is not bundled with the pulmonary medicine section services. Only, 7000 and 8000 series of CPT codes, when rarely accompany an E and M code, 25 modifier is not appended. For all other services, 25 modifier is necessary. Also, one must prioritize the dx codes carefully.
 
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