Medical billing question on CPT 99291, 99395 and UB 04

Medical Billing question and answer

Can 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.

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