BIlling 85025 and 36415 & 99397 with 99204, 99386 with Q0091


Can you bill a CPT code 85025 and 36415 together with Medicaid

Ans : No we can’t bill it.

Note : CPT 36415 will not be separately reimbursed when submitted with 85025.

Can you bill 99397 and 99204 on same day Texas Mediciad

Ans :  No.

Note :  If a health insurer bundles CPT code series 99381-99387 and 99391- 99397 with an E/M service, or vice versa, even though you had appropriately provided and coded the services, then the code bundling is inconsistent with CPT codes, guidelines and conventions. In this instance, you should review the health insurer’s medical policies for consistency with AMA CPT codes, guidelines and conventions. If the policies are consistent with CPT codes, guidelines and conventions, you should send an appeal letter for the lack of recognition of CPT modifier 25 to the health insurer, requesting reconsideration of the bundling of these codes based on CPT. This is applicable only for commercial insurance, Medicaid will not pay for it.

Can CPT 99386 and Q0091 be used together

Ans : Yes.

Note : Are you billing this to a commercial patient? If so, the pelvic and breast exam is part of the age/gender appropriate exam and should not be separately billed or paid. The Q0091 is equivalent to 99000 and some commercials pay it and some don't.  If it is a Medicare patient, you should bill Medicare for the G0101 and Q0091. Bill the patient the difference between your charge for 99385 and your charge to Medicare for the other two services. An Incidental Procedure is performed at the same time as a more complex primary procedure. The incidental procedure does not require significant, additional physician resources and/or is clinically integral to the performance of the primary procedure.

1 comment:

jeni said...

does medicaid reimburse for the cpt 85025

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