Question Urgent: Usage of G2212/99417 along with E&M - Amerihealth denying G2212 as inclusive

[Biller2023]

We billed 99205 and G2212 without 25 modifier for 99205 for chronic low back pain since provider spent more than 60 minutes, however Amerihealth denied G2212 stating inclusive. When I spoke with an agent from Amerihealth they said G2212 & 99417 are not eligible for separate reimbursement and directed me to their policy bulletin

https://medpolicy.amerihealth.com/ah/MA/Pages/Policy/7a1f46cc-2c96-4598-bfc7-607920497e50.aspx

So how do we bill in these cases when the provider spent 75 minutes for ICD 10 M54.59?

Thank you!

 

[amyjph]

It's the level 5, that's it. If their policy says not payable, there's nothing else you can do according to that policy.

 

[Cheezum51]

I don't think you need the 25 modifier. You bill the exam code on one lone and bill the G2212 on a second line with "1 unit"

 

[Biller2023]

That is how we billed but it was denied.

 

[Biller2023]

So the whole point in adding the G2212 is because the provider spent around 75 minutes. If we just bill level 5 that is only for 60 minutes so
is the provider not eligible for payment for spending the remaining 15 minutes?

 

[sls314]

So the whole point in adding the G2212 is because the provider spent around 75 minutes. If we just bill level 5 that is only for 60 minutes so
is the provider not eligible for payment for spending the remaining 15 minutes?

According to Amerihealth's policy that you linked, the reimbursement is bundled with the level 5 visit. There isn't a separate payment.

It's pretty clearly stated.

 

[amyjph]

The level 205 is 60 minutes met or exceeded.

As Susan stated, they are not going to cover it.

If the practice wants to track it internally, the code could be added to reflect that as an internal tracking mechanism. However, you can't add anything else to bill for that health plan for that extra time.