Wiki Sick visit with a well visit

[twilson@fmchosp.com]

Is anyone having success getting Medicaid to pay for a sick and a well visit the same day? I have sent the CPT guidelines and am still not having any luck. I appreciate any input. Thanks!

 

[Brenda Sue]

I work for a local Health Department and we have the same problem. We have it as policy that patient can not be seen for two visits in the same day at the same facility. Example would be child came in for sick visit, but not sick enough not to receive up to date vaccines. The E/M would pay more but they only pay for the admin fees in my department as childhood vaccines are free. So Medicaid if paying the lesser amount. Makes it harder on the patient but we had no choice.

 

[shellysk8]

Add 25

For WI Medicaid you need to append a 25 modifier to one or the other in order for both to be paid. One will be paid at a reduced rate I believe.

 

[sabarinath]

25 modifier

Hi

When u r biling for vaccines/admin with sick visit and preventive care services, as per 2013 guidelines, u have to append 25 modifier to both sick visit and preventive care codes.

For eg

99213-25-
99392-25-
90471-
90700-

Regards
Sabari L

 

[twilson@fmchosp.com]

Thanks for all of your replies. Yes we are adding modifier 25, but still not having any luck. I guess I will just keep bugging them and hopefully they will finally see that these are valid charges and should both be paid.

 

[pineapplelvr]

in our office (MN)we have to put the the office visit on a different claim...it's weird, but that's how they want it?

hope that helps

 

[Ronilynn]

In WA state I have to bill the office visit seperately with a 25 mod and it all gets paid.