Forum - Questions & Answers

Apr 13th, 2015 - amandasimpson

69210 with 99396

The pcp is trying to bill a 99396 (V70) w/ modifier 25 and 69210 (380.4) on the same claim thinking the insurance carrier will reimburse him separately for both services. I don't think they will - 69210 will be bundled with 99396. I said the only way it would be separately paid is if the claim had a 99212 or higher (medical necessity Dx)- 25 modifier and the 69210 (380.4).
Can someone PLEASE tell me which is accurate...would be GREATLY APPRECIATED!!



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