I have a payer that is denying 99386 when billed with 82274. Denial reason is "non-covered services routine exam/screening". Right now there are no modifiers except QW on the 82274. Does anyone think we could get 99386 paid by adding modifier 25? I know there are no CCI edits for this, but I find it strange that it is just this one payer that is denying.
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Wiki Preventative exam and FIT test
- Thread starter alysenb
- Start date
This sounds like a benefit issue to me - were benefits verified prior to the visit? Does the patient have a benefit for a routine exam?
kdlberg
Guru
If the payer does benefits by 365 days or 365 +1 days, the patient may have already used their preventive benefit for the time period. If it's per calendar year, I got nothing. 