Wiki 99401-99404

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Britte

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I am billing these preventative counselling codes in addition to E&M visits with modifier 25 (example 99214-25), for doctors in Indiana and in Utah. Is anyone being reimbursed for them? I am getting reimbursed for tobacco cessation counselling (99406)- but just started with these. Just curious! When I search in these forums the related info I found was several years old
 
Hello Britte,
I bill for a provider here in UT that uses the 99401 and 99402 codes with an e/m visit and we will get paid on the e/m visit but not on the 99401/99402 codes. The insurances state either a redundancy or a subset to the e/m visit. Have you had any luck being able to get payment for both services?
Thanks!
 
Hi,

Please advise, how to get payment for 99401 while billing with an E/M code. Because insurance paid E/M and denied 99401 as Non-covered charges; statutority excluded service
Thank you.
 
The 25 mod needs to go on the 99401 not EM code. Good luck.



Codes 99401–99404 may be reported separately from other E/M services (eg, office visits, preventive medicine visits) when performed on the same day. Modifier 25 must be appended to codes 99401– 99404 to signify to the payer that the preventive medicine counseling was significant and separately identifiable from the preventive medicine or problem-oriented E/M visit.
 
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