Wiki OTP G-codes help please

[Dawn442]

Hi everyone! I'm new to OTP G code billing and I am struggling to understand, I am very hopeful that you all may be able to help me. ​

Provider is billing G2074 on lets say DOS 1/26/2024 and on DOS 1/28/2024 they bill G2080. Two separate billings, not on same claim. Here are the rejections being received from Aetna.

• COB15: This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
• N674: Not covered unless a pre-requisite procedure/service has been provided.

Should I be holding all billing and sending it all out on one claim? Should I be adding a modifier to the G2080, please help!!!

Thank you in advance for any guidance you may have!

 

[dvarn567]

G2080 is an add on code and must be billed with the primary code which would be G2074. So they go on the same claim with the same DOS. We bill all services Sunday to Saturday. I attached the Medicare OTP Manual..hopefully that will help you. If you need additional help let me know as I am very familiar with billing OTP G codes.