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Thread: Help for billing code 99375 medicare

  1. #1

    Default Help for billing code 99375 medicare

    AAPC: Back to School
    I am getting denials from medicare for codes 99374-99375, stating that I am using the incorrect modifier...I have been using Modifier "GV"...Medicare denies this for inconsistency...any suggestions as to what modifer will get my claims paid? Any help appreciated...

  2. #2
    Join Date
    Apr 2007
    Hartford, CT


    There ar different codes depending on the patient's setting, 99374-75 are for patients under the care of a home health agency, 99377-78 are for hospice patients and 99379-80 are for nursing home patients. Modifier GV states "Attending physician not employed or paid under arrangement by the patient's hospice provider". If the patient is enrolled in a hospice, then the correct code would be 99377 or 99378 rather than 99374-99375. If the patient is not enrolled in a hospice then you do not need the GV modifier.

  3. #3
    Join Date
    Apr 2007

    Default Care Plan Oversite

    For Medicare patients in an assissed living facility use G0182, Medicare will not pay for care plan oversites for nursing facilites any longer.

  4. #4

    Default 99374/75

    My clearing house is denying these codes, and they are not included on the Medicare Fee Schedule. Patient is not hospice

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