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Thread: Medicare

  1. #1

    Default Medicare

    AAPC: Back to School
    why medicare does not pay 95900?

  2. #2
    Join Date
    Apr 2007


    What is it being denied for? If not considered medically necessary, check out the Local Coverage Determination for your Medicare contractor.

  3. #3
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    Aso, what other services were billed on the claim? For example, they will deny 95900 if you also billed a 95903; you would then need to check the report to determine if those studies were different nerves, and could use a 59 modifier if so. Also, as the previous responder noted, check your local carrier/MAC for an LCD. One carrier, WPS, has in their LCD that an NCS performed without EMG is screening and therefore not covered.

    Hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  4. #4


    Thank you so much. Only Medicare and Medicaid Denied this 95900. And when I added 59 to it, Medicare paid.Waiting for Medicaid response.

  5. #5
    Join Date
    Apr 2007
    North Carolina


    What was your denial? Review your local LCD to see if you have met medical necessity.


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