consult

Hi, I wanted know that does Medicaid and Amerigroup pays for consults or else they follow medicare. Does any one faced any denial regarding consult done for medicaid and amerigroup. From 2010 medicare hasn't accepted consults, so we did admits instead of consults. Does this rule is applicable to Tx medicaid and Amerigroup. Any help would be appreciated. Thanks in advance...

re: consult

Don't know about Tx but in Tennessee Medicare and Cigna are the only ones I don't bill consult codes to.

re: consult

Texas: Medicaid will continue to pay for services you bill using CPT® consultation codes.

Texas Medicaid and the Children With Special Health Care Needs (CSHCN) Services program have no plans to follow Medicare's lead in eliminating payment for these codes. Consultation codes currently payable under Texas Medicaid and the CSHCN program will remain so.

For Medicaid Qualified Medicare Beneficiary clients: If Medicare denies a claim because it doesn't cover the services billed (such as the consultation codes), submit the claim to the Texas Medicaid & Healthcare Partnership (TMHP) with the Medicare explanation of benefits that contains the relevant claim denial. Be sure to submit the claim to TMHP within 95 days of the Medicare disposition date and 365 days of the date of service. These claims will be processed as Medicaid-only claims

re: consult

thanks nancy, thank you so much

re: consult

You are welcome. from one Texan to another.