Hot Topic:
Increased Reimbursement for 95819
Published on Fri Dec 01, 2000
Question: Is it true that Medicare has issued a retroactive increase in reimbursement on the technical portion of 95819? In addition, if we provide the technical and professional components of this procedure, are we still eligible for the increased reimbursement?
California Subscriber
Answer: The Health Care Financing Administration (HCFA) recently announced a 42 percent increase in Medicare reimbursement for the technical component of 95819 (electroencephalogram [EEG] including recording awake and asleep [including hyperventilation and/or photic stimulation when appropriate]) retroactive to Jan. 1, 2000. This translates to an approximate figure of $23 per test (based on national averages).
You should file a separate bill for the difference in reimbursement. Include a cover letter explaining that you previously billed for the technical and professional component and are rebilling for the increased reimbursement for the technical component only. Do not use modifier -26 (professional component) because that indicates that only the professional component was performed.
Answered by Roger E. Kelley, MD, professor and chairman, department of neurology, Louisiana State University, Health Sciences Center, Shreveport, La.
