Forum - Questions & Answers

Dec 19th, 2011 - anil 6 

Need modifier for 96374,96375

Hai, I am receving denial for CPT® code for 96374, 96375 from MCR stating " This service/procedure requires that a qualifing service/procedure be received and covered the qualifying other service/procedure has not been received/adjudicated".
We billed 78452,A9500,93015,93674&96375. But we get the payment 78452,A9500,93015 only. 96374&96375 denied as above mentioned, i have already tried to 96374 with modifier 59,51 but again denied MCR same reason. Any ideas? CPT® was 96374,96375.

Dec 19th, 2011 -

re: NEED MODIFIER FOR 96374,96375

The administration of pharmacologic agents is considered clinically integral to cardiovascular stress tests, and does not warrant separate reimbursement. This logic is supported by the CMS guideline for Cardiovascular Services found in the National Correct Coding Policy Manual for Part B Medicare Carriers, Chapter XI which indicates that infusion and injection services are included in cardiovascular stress testing.
Therefore, procedure 96374 & 96375 is not recommended for separate reimbursement when submitted with procedure 93015. So you won't get paid even if u add modifier as well

Dec 20th, 2011 - jessaymay 2 

re: NEED MODIFIER FOR 96374,96375

we get paid for it with the 59 mod on it appeal it... we get that too sometimes its a glich in their system

Dec 20th, 2011 - nmaguire   2,606 

re: NEED MODIFIER FOR 96374,96375

http://www.trailblazerhealth.com/Publications/Job%20Aid/ChemotherapyAdministrationPartB.pdf

Jul 10th, 2016 - toniglz 1 

re: NEED MODIFIER FOR 96374,96375

I understand that 96374 is part of the "stress testing," but what if the patient has a reverse reaction and administer aminophyllin (J0280), can we then charge for 96374?



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