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Thread: Medicare IPPE

  1. #1

    Default Medicare IPPE

    AAPC: Back to School
    What to do and how to bill when all the requirements are not met?

    Example: Patient schedules for IPPE, physician writes that he has performed this service, but in review of documentation, he has not performed all the required elements necessary in order to bill this.

    I don't want to just bill 99397 (knowing Medicare will deny it and assign it to the patient). Had thought about billing with a modifier to show reduced services, but heard from the Medicare rep this would be denied as well. I'm almost inclined to bill it this way, and have it be our provider write off....

    Any suggestions????

  2. #2
    Join Date
    Apr 2007
    North Carolina


    Medicare does not allow modifier 52 on E/M services...

    "CPT modifier -52 (reduced services) must not be used with an evaluation and management service. Medicare does not recognize modifier -52 for this purpose".



  3. #3


    thats what I thought, so any suggestions on what to do in this scenario??

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