Wiki 99497-33 Denial

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lvatauchi

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Hello, everybody. I coded as below for pt. who has BCBS State Health Plan , secondary is Medicare and 99497-33 got denied by both insurance. Did I miss modifier? Spoke to BCBS Rep and was explained that advance care planning was bundled in to e/m service. I am a new biller hope someone can help me. Thank you very much in advance.

G0439 - Paid
99213 -25 - Paid
99497 -33 - Not Paid
96372 - Paid
J1885 - Paid
 
lvatauchi said:
Hello, everybody. I coded as below for pt. who has BCBS State Health Plan , secondary is Medicare and 99497-33 got denied by both insurance. Did I miss modifier? Spoke to BCBS Rep and was explained that advance care planning was bundled in to e/m service. I am a new biller hope someone can help me. Thank you very much in advance.

G0439 - Paid
99213 -25 - Paid
99497 -33 - Not Paid
96372 - Paid
J1885 - Paid
Click to expand...
If the primary insurance is Anthem, they do not reimburse for 99497 (even if modifier 33 is applied) because it is bundled to E&M. Medicare Part B covers 99497/99498 when performed same DOS as AWV (G0439/G0438) annually.
 
njycarter17 said:
If the primary insurance is Anthem, they do not reimburse for 99497 (even if modifier 33 is applied) because it is bundled to E&M. Medicare Part B covers 99497/99498 when performed same DOS as AWV (G0439/G0438) annually.
Click to expand...

Does this also go for Humana Gold Plus plans? Also does the mod-33 need to be billed with 99497 as well?
 
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