Wiki 99153 help

[elshelton]

I work in a pain management office in Georgia and we CAN NOT get Medicare to pay the 99153 we have billed in on one line with the amount of units we have billed on separate line with a 76 and we can NOT get them to pay. Has anyone else in Georgia had this problem and have you found a resolution?

 

[CodingKing]

Medicare is only paying that code to facilities. They added PC/TC indicator of 3

 

[thomas7331]

Medicare is only paying that code to facilities. They added PC/TC indicator of 3

This information isn't quite accurate - a PC/TC 3 means it's a technical-only code. So if you're billing in a facility place of service then yes, this would only be paid to the facility and Medicare is not going to pay your physician. But if you're billing in an office place of service, then Medicare should be reimbursing you for the practice expense portion.

These new codes have been discussed extensively on this forum over the past few months and it appears that a lot of payers and contractors may not be processing these correctly, so you may just need to wait until the bugs are worked out and the claims get reprocessed.