CPT® Codes 99214 and 96372 together

Please help me solve this problem for once and all. Can I bill codes 99214 modifier 25 w/code 96372 on the same claim? If I have only one dx code? What if I have 2 seperate dx codes?

re: CPT® Codes 99214 and 96372 together

Depends on the payer. Medicare will not pay. Some company denied the office visit the other day and paid the 96372. I have billed with same dx and different diag with 25 modifier. Most of them will pay.

re: CPT® Codes 99214 and 96372 together

You do need a modifier, because there is an NCCI edit. I would put the modifier on the injection code, but you may find payer variation in this.

re: CPT® Codes 99214 and 96372 together

[Depends on the payer. Medicare will not pay. Some company denied the office visit the other day and paid the 96372. I have billed with same dx and different diag with 25 modifier. Most of them will pay.]

re: CPT® Codes 99214 and 96372 together

Please answer question below

re: CPT® Codes 99214 and 96372 together

If I have an office visit 99214/25 and rocephin injection j0696 and 96372 which dx code can we use for the injection

re: CPT® Codes 99214 and 96372 together

The reason they required Rocephin

re: CPT® Codes 99214 and 96372 together

Medicare will pay both these codes. 96372 includes 99214 but it can be unbundled using a modifier 25. You can use the same DX for both codes. (the modifer 25 goes on 99214)