Forum - Questions & Answers

May 13th, 2015 - marcapnow

CO45Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.

Insurance did not pay with reason on the above subject. Can I rebill BCBS for procedure code 99203 (submitted without modifier 25)? Thanks

May 14th, 2015 - cddkc4 1 

re: CO45Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.

I am relatively new at billing; however I found this information on cms.gov. I hope it helps:

If one of the three HCPCS codes listed below is billed with an evaluation and management (E/M) code on the same day of service, previously we required modifier 25 to be appended to the E/M code for payment. This requirement has now been rescinded. The edits below identify the E/M (CPT) codes that you would manually delete from your system. Providers need to resubmit claims with E/M codes and the HCPCS listed below that have been denied for reconsideration. Adjust and reprocess previously denied claims for payment. Although we are not requiring the use of a modifier at this time, as a reminder, an E/M code should not be billed for a vaccination procedure unless a separately identifiable service was performed.



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