Wiki 99417

[KaylaRieken]

Is anyone getting paid on this CPT code? We have been getting denied saying only one visit per day.

 

[shanamarie]

Is anyone getting paid on this CPT code? We have been getting denied saying only one visit per day.

We have been getting paid for this. What else are you billing on this DOS?

 

[KaylaRieken]

99215

 

[shanamarie]

99215

I would call the payor to see why they are denying. It could be that they don’t accept 99417 and want G2212 instead.

 

[Cheezum51]

Theoretically, the G2212 is only for Medicare/Medicaid claims and the 99417 for other commercial carriers.

 

[trarut]

Sounds like the payer may have the code incorrectly defined in their claims system or an inappropriate edit set up. You may need to escalate to your provider rep to get this resolved.

 

[KaylaRieken]

Sounds great. Thanks. I figured we would have to make a phone call to them. I had our billing gal, send it documentation and a copy of what the CPT code means.

 

[shanamarie]

Theoretically, the G2212 is only for Medicare/Medicaid claims and the 99417 for other commercial carriers.

That’s what I thought as well, but you know how payors are. I have now seen policies from UHC, UMR and the Medicare replacement plans on this stating to bill G2212.

 

[SharonCollachi]

Blue Shield of California also says G2212, but then denied as bundled. We will fight, but are also discharging all of our Blue Shield patients, because we're tired of shenanigans.

 

[Cheezum51]

I had a feeling that, due to the difference in when you start calculating when the prolonged service time starts between the 99417 and G2212, that most of the commercial carriers would want to use the G2212. Sounds like that's what's happening.

 

[trarut]

Interesting. I'm not aware of any denials for 99417 as of yet. Will need to run some reports to see what's going on here.

 

[KaylaRieken]

We are getting denied on the BCBS ones.

 

[Provider492]

BCBS of Michigan wants code g2212 also