AAPC - Back to school
Results 1 to 2 of 2

Thread: Payer changing cpt codes

  1. #1
    Join Date
    Apr 2007

    Default Payer changing cpt codes

    AAPC: Back to School
    We have a payer (Caremore) that is changing our CPT codes on their end and not processing what was billed. For example 99215 was down coded to 99213. 99204 was downcoded to 99203. When discussing this with their "supervisor" she stated that their company will downcode anything greater than a level 3. I informed her that they could deny my claim but they could not change it. She then stated that anything higher than a level 3 needs documentation to pay at a higher level. Now, if our contract actually stated that, I know our providers would never have signed with them. We were told that NONE of their contracts contain any verbige to warn providers that this would be the case.

    For years I have been under the impression that a payer cannot change your submitted code without the knowledge or consent of the submitter. Unfortunatly I cannot locate anything that actually states this. There are fairly recent class action lawsuits where this issue has been part of the lawsuit but this has not deterred Caremore. Anyone out there have any words of wisdom?


  2. #2
    Join Date
    Apr 2007
    Greeley, Colorado


    I would like some information on that as well. Aetna has been changing our codes too.
    Lisa Bledsoe, CPC, CPMA

Similar Threads

  1. CMS changing CPT codes on biopsies
    By eerobinson817 in forum Medicare Regulations
    Replies: 0
    Last Post: 12-11-2013, 06:40 AM
  2. Changing ICD-9 & CPT Codes in the EMR Progress note
    By maranieves in forum EMR/EHR Systems
    Replies: 2
    Last Post: 07-30-2011, 09:26 PM
  3. Payer Changing Submitted Codes
    By shellott in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 03-05-2009, 02:04 PM
  4. Medicare changing codes!
    By Lisa Bledsoe in forum Medicare Regulations
    Replies: 2
    Last Post: 10-23-2008, 09:56 AM
  5. Changing CPT Codes/Provider permission
    By epilcher in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 06-13-2008, 06:36 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.