Medical billing question on CPT 99291, 99395 and UB 04

Medical Billing question and answer

Can CPT 99213 be billed with 96372 

Ans : No. It will not be paid.
Solution : We have to file with 20553 or any other injection code along with modifier 25 for 99213
Note : 90772 changed to 96372 for 2009

Can 99291 be billed on a UB 04
Ans : Yes. You can billed on UB 04 form
Solution : UB04 form should be use for facility code 14, 24......

If critical care codes 99291 and 99292 services billed in conjunction with admit type 1. Hospitals are required to use HCPCS code 99291 to report outpatient encounters in which critical care services are furnished. The hospital is required to use HCPCS code 99291 in place of, but not in addition to, a code for a medical visit or for an emergency department service.


Can 99395 be reimbursed

Ans : 99395 will not be separately reimbursed when submitted with CPT 90772. If the Preventative Maintenance code is billed in any other combination if E&M codes, it will not be payable.

Note :99395 when used for EPSDT services, will be reimbursed at 60% of the Medicare non-facility rate when the recipient is agae 21 or older.

99395 when used not for EPSDT, will be reimbursed at 74% of the Medicare non-facility rate when the recipeint is age 21 or older.


EPSDT CPT codes well-child visits STAGE (Age) NEW PATIENT CPT CODE ESTABLISHED PATIENT CPT CODE

INFANCY (Prenatal – 9 months) 99381 99391
EARLY CHILDHOOD (12 months – 4 years) 99382 99392
MIDDLE CHILDHOOD (5 years – 10 years) 99383 99393
ADOLESCENCE STAGE 1 (11 years – 17 years) 99384 99394
ADOLESCENCE STAGE 2 (18 years – 21 years) 99385 99395 EPSDT

EPSDT is a federally required Medicaid benefit for individuals under the age of 21 years that expands coverage for children and adolescents beyond adult limits to ensure availability of 1) screening and diagnostic services to determine physical or mental defects and 2) health care, treatment, and other measures to correct or ameliorate any defects and chronic conditions discovered [42 CFR §440.40(b)]. EPSDT requirements help to ensure access to all medically necessary health services within the federal definition of “medical assistance”.

Annual wellness with STI screening: For Annual wellness with STI w screening use the following CPT Codes: Adult preventive care visits New patient

CPT Code 99385: Initial Preventive Medicine New Patient age 18-39 years
CPT Code 99386: Initial Preventive Medicine New Patient age 40-64 years
CPT Code 99387: Initial Preventive Medicine New Patient age 65 years & older Established patient
CPT Code 99395: Periodic Preventive Medicine Established Patient 18-39 years
CPT Code 99396: Periodic Preventive Medicine Established Patient 40-64 years
CPT Code 99397: Periodic Preventive Medicine Established Patient 65 years & older

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