Q: I'm currently receiving a rejection for my billing with BCBS. We've entered 20550 and 20600 as services for the visit. our billing service is saying that they're only allowing 20600 and want to add a modifier to 20550 to get this paid. I'm unaware of what modifier we should use. any suggestions?
A: The most common modifiers for 20550 as per Medicare are listed below. Make sure that whichever modifier you choose is applicable and is supported by the documentation. If none of these are applicable you should check the NCCI edits, or look up the codes on Find-A-Code™ to see more modifiers. If you don't have a Find-A-Code™ account you can create a free trial and view the information, even do a check on the NCCI edits there. When I looked it up it indicated that 20600 would be the only one paid without an applicable modifier, though BCBS could have their own policies regarding the payment and which modifiers are applicable. You may also want to check their policies, and can do so with a free trial at Find-A-Code.
Modifier 58: Staged or Related Procedure or Service by the Same Physician During the Postoperative Period: It may be necessary to indicate that the performance of a procedure or service during the postoperative pe Modifier 59: Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: It may be necessary to indicate that another Modifier 79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period: The physician may need to indicate that the performance of a procedure or service during the postoperative period
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Chiropractors treat, among other things, issues with the musculoskeletal system. Active therapeutic procedures are accepted as effective ways to treat many common conditions and therefore can be billed and generate revenue for a clinic. Two common CPT codes that might be used in a chiropractic setting include:
More than 43% of Medicare beneficiaries are not enrolled in Medicare Advantage plans, which were established to control costs and improve quality. However, as noted in the March MedPac Report Executive Summary of 2021, these plans average an estimated 104% of Medicare Fee-For-Service (FFS) spending. How does CMS plan to manage Medicare Advantage plans now?
Providers need to begin preparations for how to handle a return to pre-COVID-19 public health emergency (PHE) policies. As the saying goes, "you can't put the rabbit back in the hat." Some COVID-19 PHE policies are so well liked it will be very difficult for the government to return to pre-COVID-19 policies. For now, we have at least the promise of a 60-day notice to all governors precipitating the end of the PHE.
Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...
Question: If CCM hours/work is to be billed monthly, and CCM tasks are done daily throughout the month, should it be saved until the end of the month to bill, and should each date be billed as DOS in one claim?
Answer: According to CMS, “The service period for CPT 99490 ...
When reporting CCM or TCM codes, you will only get reimbursed for what is allowed. The E/M office visits can be coded in addition but are not interchangeable with CCM codes. You can bill an E/M visit during the time a patient is under Care Management, however, you can’t count time ...
Question: Is there a financial penalty for billing over the allowed amount?
Answer: Yes, if you are submitting claims to a contracted provider, you cannot bill over the contracted amount of your fee schedule. This is called balanced billing. There is also the no-surprise rule that protects insured and non-insured or ...