# 99499 v. 99231-99233



## jewlz0879 (Aug 17, 2011)

Per Medicare as of 2010: 

*Append modifier AI only if you are the admitting physician/principal physician of record.

† Providers should report 99499 when the minimum key component work and/or medical necessity of an initial facility service code were not medically required or were not documented. Reporting 99499 requires the submission of medical records and contractor manual medical review of the services prior to payment. Alternatively, providers may report a subsequent care code that appropriately reflects physician work and medical necessity of the service. Reporting a subsequent care code avoids mandatory medical record and manual medical review.

We are billing with 99499 when the criteria for 99221 is not met yet we are receiving no payment from Medicare when billing this code and sending the records. I see where Medicare suggests we can bill the subq codes in place. Is anyone doing this? Is anyone using 99499 and getting paid? 

Any suggestions are greatly appreciated!


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## RebeccaWoodward* (Aug 17, 2011)

jewlz0879 said:


> Per Medicare as of 2010:
> 
> *Append modifier AI only if you are the admitting physician/principal physician of record.
> 
> ...



When 99221 can't be achieved, we are submitting the subsequent codes and getting paid.  I only use 99499 as a last resort


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