NY State United Healthcare community dual coverage

[MARY K]

Just wondering if anyone else in physician billing getting a denial for an E/m billed with an X-ray as inclusive? When I called I was told the E/M is part of Xray and must bill E/M with 25 modifier. Looking for help, and or link for correct billing? New to dual coverage thru state

 

[rvary231]

From my experience, their response is correct. Because an x-ray is considered a more significant procedure than the E/M, you have to append modifier 25 to indicate the provider should be paid for both an exam and the x-ray. I think Dual Complete through UNHC behaves very similar to Medicare in what they look for on claims. Although, they don't always follow that!

 

[dayci.a.torres@gmail.com]

yes i second that, UHC respond is correct, you must append a modifier, it is part of the NCCI edits for those procedures billed with E/M visit code, in order to be consider for payment add modifier 25.

 

[MARY K]

Thank you