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Thread: I need input, please help

  1. #1
    Join Date
    Apr 2007

    Question I need input, please help

    AAPC: Back to School
    Can anyone tell me if this is how this should be billed to medicaid? I am not familiar with primary care billing I work in OBGYN but was asked this question. Any info will be appreciated.

    example 1
    99394 dx. v20.2
    92551 dx. v20.2 ($0) does caid not py for these two services?
    99173 dx. v20.2 ($0)
    36415 dx. v20.2
    81002 dx. v20.2

    example 2
    99395/25 dx. v70.0
    94760 " " ($0)
    99173 " " ($0)
    36415 " "
    81002 " "
    80061/QW" "
    82120 " "
    A4402 " " ($0)
    Q0091 " " ($0)
    99212 dx. 9392

  2. #2


    Example 1:

    Medicaid does not pay for 99173 and 92551 but you must bill for these services in order to meet the requirement for an EPSDT. And you also must use DX code V20.2.

    Example 2:

    Medicaid will only pay for one service per day. You can bill the physical or the E/M visit but they will not pay for both even with a modifier.

  3. #3
    Join Date
    Apr 2007
    Alexandria, VA


    I agree w/Jacqueline on Example 1


    Example 2--Our State Medicaid pays for both (9939_ + 9921_(25)) when we billed 9939_ with different DX than 9921_ (25) also modifer on E/M code..
    Scenerio--Pt scheduled for preventive visit on date of service and when pt arrives he has a "by the way" problem ....This is a good reason to bill both.

    Hope this helps...


  4. #4
    Join Date
    Apr 2007

    Smile thanks

    Thank you both for your valuable insight. This has really helped.

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