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99354 reimbursement

  1. #1
    Question 99354 reimbursement
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    Hi everyone. I just received a denial from united healthcare on the prolonged code 99354 stating charge is included in the global service. I have other carriers who are paying this code with no issue. Has anyone else run in to this situation? If so, did you appeal? Thanks

  2. #2
    Columbia, MO
    Yes you appeal, to deny this is popular with united in my experience, however with a good appeal it has always been successful. Your documentation must have face to face physician time documented in the physicians progress note, I have had some difficulty recently when the physician did not document as time in and time out as opposed to total time spent. If this is not documented by the physician then an appeal will not be successful.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default 99354 reimbursement
    Thanks i will recheck the documentation and appeal this denial. This particular doctor is very good with her notes so i will give it a try.

  4. #4
    Ft. Myers, FL
    Default UNHC 99354 denials
    Medical Billing
    I too have found UNHC to stereotypically deny the prolonged code on the initial submission. As a matter of fact, this is so common in our practice, that we have a form letter where we just change specific claim/patient info in the letter and send it off with a copy of the note. I do agree that you need to make sure your doc's notes specifically indicate total face to face time spent with patient. I have never been denied an appeal from United after the letter and chart notes are sent. Sometimes it seems insurance companies purposely deny additional codes initially in hopes that providers just write them off and don't pursue an appeal. UGH!

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