Wiki Refraction's and medicare

[cpccoder2008]

We were always under the impression we had to submit refractions to medicare even though they would not pay, but is it required ?? The only thing i can find on the subject is this http://www.lamedicare.com/provider/datanaly/faqs.aspx?action=1&faqID=1410

 

[vpcats]

We were always under the impression we had to submit refractions to medicare even though they would not pay, but is it required ?? The only thing i can find on the subject is this http://www.lamedicare.com/provider/datanaly/faqs.aspx?action=1&faqID=1410

You do not have to submit any non-covered services UNLESS the patient demands that you send in a claim for them. The patient may want to see the actual denial, they may need it to submit to another insurance or additional coverage they may have, for tax purposes, etc. Attach a GY modifier to the CPT code if you have to submit.

If you list the refraction on the claim along with any other COVERED services and if by any chance list a paid amount for the refraction, Medicare will think the payment is for the covered service and will reduce your payment by that amount.

 

[aguelfi]

No it's not required, however some patients want to see the denial and occasionally others have a secondary that will pay. In that case you need to submit to MCR to get the denial for the 2ndary.