Wiki 99549 with Preventive for United Healthcare

[mccormickk]

UHC keeps telling me that 99459 can be billed with preventive if we add a modifier. Given this is an add-on code, a modifier would not be appropriate. Has anyone had success appending a modifier to this to get the 99459 paid? If so, are you adding -25 to the 99459. Very frustrated as a private practice and no longer have a direct provider rep. I have spent over 3 hours on chat with no resolution on why or when it would be appropriate to add a modifier so hoping someone may have some information to share.

 

[csperoni]

You are correct that 99459 is an add on and a modifier SHOULD NOT be required. However, from my personal experience, UHC and Oxford were doing all sorts of funky things, particularly at the beginning of the year. Like paying 99459 and denying the E&M. Applying a copay to 99459 when billed with 9938x-9939x. Bundling 99459 into E&M and bundling E&M into 99459, paying neither. We found that adding -25 on the E&M/preventive/consult allowed payment for both. We considered it a payor guideline, which can override coding guidelines.
I believe the most recent information my department received from our payor contracting department is that as of 10/1/24, 99459 will be bundled and never paid. I haven't seen it myself in writing, but that is what I heard.

 

[mccormickk]

You are correct that 99459 is an add on and a modifier SHOULD NOT be required. However, from my personal experience, UHC and Oxford were doing all sorts of funky things, particularly at the beginning of the year. Like paying 99459 and denying the E&M. Applying a copay to 99459 when billed with 9938x-9939x. Bundling 99459 into E&M and bundling E&M into 99459, paying neither. We found that adding -25 on the E&M/preventive/consult allowed payment for both. We considered it a payor guideline, which can override coding guidelines.
I believe the most recent information my department received from our payor contracting department is that as of 10/1/24, 99459 will be bundled and never paid. I haven't seen it myself in writing, but that is what I heard.

Thank you Christine- I had heard similar but again, with no longer having dedicated provider rep, very frustrating to confirm these policies. Agree with you on the payer requirement superseding and normally we can find written policy of when appropriate to add the modifier yet nothing I have been able to find to support keeping our money if we were bill and support in an attempted take back.