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Thread: Apheresis-2x same day/provider

  1. #1

    Default Apheresis-2x same day/provider

    AAPC: Back to School
    In Virginia Medicare will not accept the Modifer 76 for a paitient that had apheresis
    2x on the same by the same provider. We have thought about billing x2, but do not want hold up payment or cause another denial. Does anyone have any suggestions, please?

    36514-we have looked at several websites and cannot find anything to address this.
    Does anyone know of a specific area we can check?


  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    Per Pub-100 references (100-4,4,231.9) apheresis is not billed by units but on a per visit basis. The Medically Unlikely Edit is for one unit per DOS. There is also an NCD regarding apheresis.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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