CPT® codes 95903-59, 95904-59

I just got a refund/recoupment requestfrom Medicare for all payments for the above codes that were paid in 2012. They were billed with 95861. I know we couldn't bill them without the modifiers and so added the modifiers and got paid. Now they're asking for their money back. Can they do that? Has anyone else gotten a refund request?

re: CPT® CODES 95903-59, 95904-59

Absolutely! They are, after all, the federal government. You should consider yourself lucky that they are only asking for their money back. Coding claims for the sole purpose of getting them paid is considered FRAUD! You by your own admission stated that you knew this was wrong yet you did it anyway. Just be thankful you aren't standing in front of a federal judge!

re: CPT® CODES 95903-59, 95904-59

Actually, I said I knew I could not code WITHOUT the modifier 59 so I coded WITH the modifier. I did NOT say I knew it was wrong to code the way I did, otherwise I obviously would not have done so.