Forum - Questions & Answers

Apr 10th, 2015 - vochrisq 3 

medicare reimbursement

I have been getting denials for CPT® 99223 when billed with a procedure, example 36556.
I bill the 99223 with modifier 57, decision for sx, and 36556. EOB will come back with procedure paid but not the consult. EOB states payment is included in another payment/allowance already adjudicated.

What does that mean? and am I billing incorrectly?

Thanks

Apr 10th, 2015 - ellis3350 2 

re: medicare reimbursement

Use a 25 modifier on the 99223 instead of the 57.



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