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95941 - nobody is paying this

  1. Default 95941 - nobody is paying this
    Medical Coding Books
    nobody is paying this code I really need help!

  2. #2
    Location
    Wausau, WI
    Posts
    59
    Default
    95941 is an add-on code. Are you billing with the one of the codes listed in the notes?
    Ellen Elia, CPC, COBGC

    You are never to old to set another goal or to dream a new dream. C. S. Lewis

  3. #3
    Default
    Quote Originally Posted by Emmy1260 View Post
    95941 is an add-on code. Are you billing with the one of the codes listed in the notes?
    And MCR has gotten increasingly funny about add-on codes lately. Modifier 59 might have to be added to 95941 even if it is linked to its proper parent code.

  4. #4
    Location
    Denver Colorado
    Posts
    287
    Default
    +95941 is not a covered code for Medicare. They created the G0453 HCPCS code to report the remote monitoring scenario.

    Where there may be some catch is that Medicare also did not include any RVU valuation for this code; so it will be left to the commercial payer to figure out they will pay if they cover this service.

    You may want to check with the commercial payer to see if they cover the services described by 95941. It may be that they also adopted the G0453 code.

  5. Unhappy 95941
    We have the G code for medicare down. That seems to be working. We are using the proper add on codes for the 95941 and its still not paying with commercial insurances.

    Here is am example with United Health Care

    95941, 95938, 95870 they are denying the 95941saying its not reimbursable.

    Same issue with Blue Cross they do not like the 95941 its not in their system at all. They also do not have the G code.

    Modifiers. We bill with 26, 59

    tried taking off the 59. that still did not work. Now we are being told to remove the 26 modifier. However it seems thats not going to work either.

    Could this be an issue with the RVU's Do we just need to wait it out until the commercial insurances update their systems? This is extremely frustrating. Our office does Intraoperative Monitoring so this is a big issue with us. Any other suggetions?

  6. #6
    Location
    Denver Colorado
    Posts
    287
    Default
    The 95940, 95941 and G0453 codes do not have separate professional and technical components, so reporting may actually cause a payer denial.

    More likely the denial for 95941 is that the code carries a 0.00 RVU in the 2013 Medicare Physician fee schedule with a "I" status indicator or Not Valid for Medicare - Medicare uses another code for reporting of, and payment for, these services. This is the same status indicator that the consult codes have in the Physician Fee Schedule. The difference though is that those codes still have RVU valuations listed so that payers that do cover consultation services can continue to use the Medicare RBRVS to process the codes. With 95941, the payer would need to establish their own allowable for this code.

    I have heard some anecdotal comments that some commercial payers are using the G0453 code for remote monitoring services, possibly since it has established RVU! However, the code description is "attention directed exclusively to one patient" which is different from the 95941 code.

    I would recommend checking with the payer to see how they are covering IONM for 2013.

  7. #7
    Location
    Denver Colorado
    Posts
    287
    Default
    Oops the first sentence should have been:
    The 95940, 95941 and G0453 codes do not have separate professional and technical components, so reporting with modifier 26 may actually cause a payer denial.

  8. Default
    Do we need to use the G code for NY Medcaid patients as well?

  9. Default 95941
    Denials for 95941 is still a huge problem! I know that G0453 has been added for medicare but has there been any updates on how to get 95941 paid when billed with codes 95870, 95938, 95939 or 95926 for commercial plans?

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