amacias
New
I have a provider that is appealing a claim that was denied. One CMS 1500 claim form with 2 different rendering providers.
Line 1 - One CRNA bills 01967 QX U2
Line 2 -different CRNA billed the add on code 01968 QX U2.
Line 2 is denied on the claim, missing primary code. The denial is correct, but they are appealing stating TMHP (Texas Medicaid) provider manual does not clearly state 2 different rendering providers cannot bill as stated. They reference section 9.2.7.9.2 of TMPPM - Modifiers QX and U2 must be submitted by a CRNA, AA, or other qualified professional who provided services under the medical direction of an anesthesiologist.
I want to uphold the denial, but cannot seem to find a citation where it clearly states the rendering provider must be the same on the claim in order for line 2 to pay (the add on code). I did reach out to Optum and they stated the rendering providers have to be the same, but a citation was not provided. I would appreciate anyone's assistance.
Line 1 - One CRNA bills 01967 QX U2
Line 2 -different CRNA billed the add on code 01968 QX U2.
Line 2 is denied on the claim, missing primary code. The denial is correct, but they are appealing stating TMHP (Texas Medicaid) provider manual does not clearly state 2 different rendering providers cannot bill as stated. They reference section 9.2.7.9.2 of TMPPM - Modifiers QX and U2 must be submitted by a CRNA, AA, or other qualified professional who provided services under the medical direction of an anesthesiologist.
I want to uphold the denial, but cannot seem to find a citation where it clearly states the rendering provider must be the same on the claim in order for line 2 to pay (the add on code). I did reach out to Optum and they stated the rendering providers have to be the same, but a citation was not provided. I would appreciate anyone's assistance.