Wiki 97014 question

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kcorman

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I am noticing that United HealthCare is not paying for 97014. Is there another procedure code for electric stimulation therapy that insurance will pay on. Thank you!!
 
kcorman said:
I am noticing that United HealthCare is not paying for 97014. Is there another procedure code for electric stimulation therapy that insurance will pay on. Thank you!!
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What exactly is the denial? Is it billed with any other therapy codes the same day? We generally don't get paid by UHC for 97014 either, but it is a valid CO45 "denial", due to our contract with UHC.
 
I bill out a 97010 with the 97014. The denial says this is not a reimbursable service. There may be a more appropriate cpt or hcpcs code that describes this service and/or the use of the modifier or modifier combination is inappropriate. I do not use a modifier for a 97014.
 
Hi there, just FYI - 97010, hot/cold packs, has not been a billable service in quite a long time. I've been gone from PT/OT billing since 2007 and we had not been billing that in years before I left.

What else are you billing with the 97014, look at your CCI edits. You may need a -59 on some codes.
 
I believe that G0283 should only be used for Medicare plans. OP did not specifiy this, so I was assuming it was commercial. The only other thing I can see, is that United requires us to use the GP/GO modifiers for therapy services. Might want to check into that.
 
I only use the G0283 with Medicare and the GP modifier for medicare too. I didnt know that I could use a GP modifier for commercial insurance.
 
Kcorman, the GP/GO modifiers are only for Medicare not commercial insurance. If you use them, more than likely the claim will be denied. However, check with your carriers if you need clarification.
 
We use G0283 for all Medicare, Medicaid, and United Health Care claims. Of course, the UHC does not need the GP,GO, or GN modifiers.
 
Reimbursement Policy

UHC has a reimbursement policy specific to 97010 and 97014. Use of a modifier will not over-ride the denials. The G codes can be billed IF appropriate (and if for Medicaid they are covered in that specific State by Medicaid FFS). For commercial you can find the policy on www.unitedhealthcareonline.com, and for Medicaid you can find the policy on www.uhccommunityplan.com.

Thanks,
Shelly
 
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