Wiki NY Medicaid now ignores modifier 25

[Akulo]

So I bill in new york and when I bill Medicaid for patient's Medicare HMO's co-insurances, they now deny the second line item. If I bill 17110 and then 99212-25, they'll deny 99212 and pay 17110. If I bill 99212-25 & 17110, they'll deny 17110.

Their explanation is they bundle the two codes and now ignore modifier 25. They also said they'll only pay the first line item and not the second... apparently it is a "NEW" thing. Does anyone else have this problem?

 

[ellzeycoding]

Normally E/M is included in minor procedures (at least for CMS and most carriers) and is not billed separately. Was it a separately identifiable E/M (above and beyond the E/M related to the destruction)?

If not, appeal with notes.

Ask for the policy in writing as well.

 

[Akulo]

Normally E/M is included in minor procedures (at least for CMS and most carriers) and is not billed separately. Was it a separately identifiable E/M (above and beyond the E/M related to the destruction)?

If not, appeal with notes.

Ask for the policy in writing as well.

I'm actually getting no where with them.

I called them and they told me starting July 2016 they're not paying for the second CPT code even if there's a modifier 25. They're actually recouping payments now that paid for office visit and procedure from July 2016 to now.

I asked them to direct me where it says this in writing and was directed to this link below, which doesn't say anything relevant to this.
https://www.health.ny.gov/health_care/medicaid/program/update/2016/jul16_mu.pdf