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Thread: Billing Sick visit with Preventative Visit Reimbursement

  1. #1

    Cool Billing Sick visit with Preventative Visit Reimbursement

    AAPC: Back to School
    Wondering if anyone else is experiencing this? When billing a 99213-99215 with a Preventavive visit code we are not being reimbursed 100% on both E & M codes. We are being reimbursed only 50% on one and then 100% on the other. Am I missing something?
    Any help would be greatly appreciated.

    thank you,

  2. #2

    Default Billing for split visit

    When you bill preventative with an E/M in order to get reimbursed properly you can not charge them out at full price. The Preventative visit is billed out at full price then the E/M visit is billed out by taking the Preventive cost minus the E/M charge then subtracting the difference from the E/M. I hope you can understand what I have written.

  3. #3

    Default Payment methodology

    This has been Medicare's payment methodolgy for years. However, it has been fairly recently that insurance companies are jumping on this cost-saving measure. This is assuming they are even allowing payment for both; some insurances are non-allowing one or the other (typically the office visit), stating it is bundled due to the nature of the services rendered.

  4. #4
    Join Date
    Apr 2007


    That is how you get paid with a Preventive visit as well as a sick visit. Do not change the prices of the services. When you add the Mod 25 to the Prev visit you should get paid in full for the Prev visit and 1/2 for the sick visit. That's how we have been getting paid for years. Some insurance companies will not pay both. Most of the larger carriers will.

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