Need modifier or inclusive? - I am billing an inpatient hospital

catmedfile

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Hi All,

I am billing an inpatient hospital consult along with CT scan reads with the 26 modifier - Medicare and MediCal pay with or without the 25 modifier on the consult, but other company's (HMO's that are supposed to be using MediCal guidelines as these are MediCal patients) are denying the CT scan reads as inclusive. Does the consult need a 25 modifier even tho MC and MediCal are paying without it. Or are the reads inclusive and MC and MediCal are wrong?

Thanks so much,
Catherine
Neurosurgery Billing Department
 

cgaston

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Every carrier has their own rules/regulations. If a carrier wants the -25 then that is what you have to do when you bill them.

We have cheat sheets galore covering things such as which carriers accept consultation codes and which ones don't, which ones use G codes and which ones don't...sounds like you're going to need on for which ones want -25 and which ones don't.
 
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