MediCare denial CO- B15 - 95903 (59) and 95904 (59)

Not that I am trying to be tricky or find a way around appropriate billing, however - is there a better suited modifier when billing 95860, 95903 (59), and 95904 (59)? Up until recently MediCare was paying these services, as of 10/1/2012 they have started denying service with CO-B15 (This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated.) Anyone out there have any advice? All responses are much appreciated!

re: MediCare denial CO- B15 - 95903 (59) and 95904 (59)

Looks like you shouldnt be billing these 2 together. As per the notes in the begining, maybe look at 95885 as add on code.....not my specialty tho.
As per CCI edits no modifier can be used


Code / Description
95860 MUSCLE TEST ONE LIMB M Non-Facility RVU: 2.82


No bundling issues exist
95903 MOTOR NERVE CONDUCTION TEST M Non-Facility RVU: 2.21


Code 95903 is a component of Column 1 code 95860 and cannot be billed using any modifier.

re: MediCare denial CO- B15 - 95903 (59) and 95904 (59)

Thanks for the response --
Primary procedure 95860/95861 (no modifier), we then bill the 95903 (59), and 95904 (59). Historically MediCare was paying on these services, it wasn't until recently they've stopped and denied these services with CO-B15.
(They are still paying the main procedure 95860 or 95861, they are denying the 95903 and 95904).

re: MediCare denial CO- B15 - 95903 (59) and 95904 (59)

I bill for a Rehabilitation/sportsmedicine physician and following the rules of Medicare, for the EMG/NVS studies, I make sure the make and model number of the equipment used for the test is in box 19 on the cms1500. Also, you will not want to use 59 for the modifier. You will want to use KX for the 95900, 95903, 95904. This modifier tells the contractor that " specific required documentation is on file." I have no problem getting them paid.

re: MediCare denial CO- B15 - 95903 (59) and 95904 (59)

Thank you! Your information was most helpful.

re: MediCare denial CO- B15 - 95903 (59) and 95904 (59)

Did this work for you, because I knew of the new changes regarding KX modifer and equipment information. My claims were still denied same as yours.