Originally Posted by lopezk89
I have tried to put modifiers ie. 59 76 if both then also I am getting this is not a covered benefit but then I get paid on it sometimes I don't know any more I just want it to be consistent . I also have gotten a coding denial for the code it self I am using the HCPCS code so I am confused I just need to know.
Not all payers allow for this. That is probably why you are getting some denials even though you are billing them all the same.
I think it would be a good idea to check with your top 10 payers and find out if this is a covered benefit. It should not require the modifiers you are using below. I think it's a matter of it being a non covered benefit for that payer. Some payers may require that you use an unlisted HCPCS code and send in the invoice and they will price it based on your cost.
The reason it is important to find out is so you can address with the patient how it will be paid before they receive it. Once you know how your big payers will handle it, you will really reduce the amount of time you're spending dealing with it and you will be able to collect up front from the patients whose insurance does not pay for it.