Wiki Secondary insurance not paying because CPT codes are not in the contract.

glielmia

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Local Chapter Officer
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Bensalem, PA
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We are having a hard time receiving payment from our 2nd insurances because the CPT and modifiers codes of the secondary are not in their contract. We are a telemedicine company . Here is an example:

Medicare is primary and they do not use any modifier for telemedicine. We bill the secondary and they deny because they don't accept G codes and they require a modifier of a GT or 95. There was no coordinating of benefits on the initial EOB that we received from Medicare so the claim goes directly to the 2nd insurance company after we dropped the bill directly to them.

Can the secondary refuse to pay for this reason? If they refuse can we bill the patient directly?
 
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