what modifier for cpt 95970 and 99214 or 99244

tgjt1234

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what modifier for cpt 95970 and 99214 or 99244?

Doctor sees a patient and during visit he makes an adjustment to his VNS implant. The diagnosis code needs to be 345.5x, what modifier would get both services paid? Commercial insurance requires a modifier, Medicaid does not. I appreciate your help.
 
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Hi,

I looked up your codes on CCI Edits and it shows that the 99214/99244 would require a -59 modifier to "unbundle" it from the 95970.

Also, just a pointer....be careful how you word your questions. You don't use modifiers to "get things paid", you use them to indicate to payors that services normally considered "bundled" are in a specific case not so, to accentuate the accuracy of coding, and so on....not to "get things paid". I get what you're asking but don't want your statements to be misinterpreted and cause you problems.

Hope this helps!
 

tgjt1234

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Winter Park, FL
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Thank you.


Hi,

I looked up your codes on CCI Edits and it shows that the 99214/99244 would require a -59 modifier to "unbundle" it from the 95970.

Also, just a pointer....be careful how you word your questions. You don't use modifiers to "get things paid", you use them to indicate to payors that services normally considered "bundled" are in a specific case not so, to accentuate the accuracy of coding, and so on....not to "get things paid". I get what you're asking but don't want your statements to be misinterpreted and cause you problems.

Hope this helps!
 
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