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Wiki NST in office procedure

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samantha Martel

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Hello,

We are getting a denial from MVP for an NST 59025-26 because it was done in a hospital setting. They are saying it is an in office procedure. We put mod 26 on because we do the reading, but they are still saying it isn't payable. Has anyone heard of this before? We haven't had a problem with this in the past and NST's are commonly done at the hospital.

Thank You!
 
Why would they refuse?!
If the procedure is performed in the office setting and the physician owns the
equipment, code 59025 is billed withoutmodifiers, as it represents both technical
and professional components. I think this is more reasonable.
If this procedure is performed in the hospital, the physician reports the service with
modifier -26 (Professional component).
TC component goes for the hospital.
 
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