Wiki Child Well Visit with Sick Visit

We have sent several claims to the insurance since they do not pay us for the child well visit along with the sick visit which they do. We have used the modifier 25 alone, then only AM and finally 25 and AM together in CPT 99391 but the insurance still continues to deny preventive child care. Could you help me resolve this question?

Have you tried calling the insurance company? Select Health Medicaid won't pay for both no matter what. What is CPT 96161 used for?

elizabethsalinas1805@gmail.com said:

We have sent several claims to the insurance since they do not pay us for the child well visit along with the sick visit which they do. We have used the modifier 25 alone, then only AM and finally 25 and AM together in CPT 99391 but the insurance still continues to deny preventive child care. Could you help me resolve this question?

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In Mississippi, Medicaid we use EP instead of AM I will use your reference on how we would have to submit the claim. Also you may want to question your provider about the use of 99214 for a URI dx. In my practice, Internal Medicine & Pediatrics, when I have reviewed charts, I have never seen a 99214 for a simple URI done with a wellness exam.

99391 EP;25
99214 25
96161 EP;XU
90723 EP
90648 EP
90460 EP 2 units
90461 EP 5 units

ny2scgirl said:

Have you tried calling the insurance company? Select Health Medicaid won't pay for both no matter what. What is CPT 96161 used for?

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96161 is for a Maternal Depression screening.

Thanks for the information, so do you know how it works in Texas? Because when we call to the insurance, they only told us that we need two modifiers, but they still denied the payment.

elizabethsalinas1805@gmail.com said:

Thanks for the information, so do you know how it works in Texas? Because when we call to the insurance, they only told us that we need two modifiers, but they still denied the payment.

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Sorry I dont.

i billed the cpt code 99391 with the EP modifier ...and it's still getting denied...

HI if you are in Texas - EPSDT/VFC billing - Refer to the Texas THSteps guidelines: Per the guidelines E/M sick visits have to be split from the EPSDT visit. The "Acute Care visit E/M" must have the modifier 25
Parland Community Health Plan follows THSteps guidelines