Wiki 96110 ASQ denial from BCBS SC

[SA91]

Hi all,

Has anyone received reimbursement for the 96110 from BCBS SC or any BCBS carrier? The 96110 is mainly being billed with our Well Child visits.

We bill the 96110 with modifier 59 and this denied for the following explanation BCBS gave us : CPT code 96110 was not bundled with any other codes on this claim or any other claim. Rather, this code is considered a component of another service which should be filed by the provider (i.e., E&M, medical care, consultations, surgical care). Based on CMS billing guidelines, it is not considered an independent procedure in this place of service and therefore, is not considered a separately reimbursable code.

I have tried to use another CCI modifier in the past but of course this will get denied as explained above by BCBS. I have alos tried filing a reconsideration and they still up hold their decsion.

I would appreciate some insight for this issue.

Thank you!

 

[rthomas@impcna.com]

Hi all,

Has anyone received reimbursement for the 96110 from BCBS SC or any BCBS carrier? The 96110 is mainly being billed with our Well Child visits.

We bill the 96110 with modifier 59 and this denied for the following explanation BCBS gave us : CPT code 96110 was not bundled with any other codes on this claim or any other claim. Rather, this code is considered a component of another service which should be filed by the provider (i.e., E&M, medical care, consultations, surgical care). Based on CMS billing guidelines, it is not considered an independent procedure in this place of service and therefore, is not considered a separately reimbursable code.

I have tried to use another CCI modifier in the past but of course this will get denied as explained above by BCBS. I have alos tried filing a reconsideration and they still up hold their decsion.

I would appreciate some insight for this issue.

Thank you!

We receive payment from BCBS Mississippi. We bill it at the 18 month check up when we do the MCHAT assessment. What diagnosis are you using? Here is an example of how we bill:

99392 25 Z00.129
96110 XU Z13.41
90656 Z23
90460 Z23

 

[SA91]

We receive payment from BCBS Mississippi. We bill it at the 18 month check up when we do the MCHAT assessment. What diagnosis are you using? Here is an example of how we bill:

99392 25 Z00.129
96110 XU Z13.41
90656 Z23
90460 Z23

Thank you! This is great I appreciate it I believe the Z13.41 may help! I will post if this was successful

We would use the Z00.121 or Z00.129 (this per the practice instructions) and I wanted to get some insight from other practices appreciate it!