Forum - Questions & Answers

Aug 18th, 2015 - alpjeffrey 14 

96372 denial by medicare

I have a claim that has two 96372 on the form because we did two different injections. Medicare is denying it saying it is bundled with something else but they can't tell me what. I was going to see if someone could help.

Here are the codes on the full claim:
99213 -25
81001
53660
J1580
J0696
96372
96372

Aug 18th, 2015 - petunia 195 

re: 96372 denial by medicare

the other injection would need a modifier 59 or one of the new x modifiers

Aug 18th, 2015 - catclayton 6 

re: 96372 denial by medicare

I've been having the same problem. It has only been recently that they have been paying the Jcodes but denying the 96372. We bill a 96372 X# of Jcodes we have and I add a 59 mod on the 96372 now and that has seemed successful so far.

I would have billed those codes as follows
99213 - 25
81001
53660
J1580
J0696
96372 X2 quantity - 59

Good luck. Hope that helps!



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