Wiki Remote physiological monitoring 99457 during global period

[SMorris13]

Our provider billed for 99457 eight days after a minor procedure performed in office so we added modifier 24 to 99457. However the payer is rejecting this upfront due to invalid/missing modifier. Is anyone here able to shed some light on what the issue might be? An E/M was also billed on the same day as the minor procedure, so I wonder if that could be part of the problem?
We have been successfully billing RPM for a while on this same patient with the same dx.
I appreciate any advice you might have. Thank you in advance!

 

[thomas7331]

Modifier 24 is for use with evaluation and management codes. My guess is that the payer is not classifying 99457 as an E/M service and because of this is identifying the modifier as invalid for the code. If they are considering this a diagnostic test code, that would not be part of global package and so a modifier shouldn't be required - I would try filing it without the modifier.

 

[SMorris13]

Modifier 24 is for use with evaluation and management codes. My guess is that the payer is not classifying 99457 as an E/M service and because of this is identifying the modifier as invalid for the code. If they are considering this a diagnostic test code, that would not be part of global package and so a modifier shouldn't be required - I would try filing it without the modifier.

Thank you for the suggestion, I will try that!

 

[SMorris13]

Modifier 24 is for use with evaluation and management codes. My guess is that the payer is not classifying 99457 as an E/M service and because of this is identifying the modifier as invalid for the code. If they are considering this a diagnostic test code, that would not be part of global package and so a modifier shouldn't be required - I would try filing it without the modifier.

I wanted to follow up on this to say that I took your suggestion and removed the modifier and the claim was paid. Thank you!!