Wiki ACP 99497/ AWV/ E-M code

[aksilvis]

I have a provider that tends to see pts for their AWV, ACP and often a seperate E/M code on the same visit. Lately I am being told that insurance will not cover the ACP 99497 portion of the visit. We are billing it with a 33 modifier (which is how we have always billed it) I am at a complete loss. I've researched everything I can think of. Is there anyone with any experience in this area that can help me out?

 

[trarut]

Have you checked the individual payer policies for the ones denying this combination of services? It could be a coverage policy but may be a reimbursement policy or a published claim edit. The payer may also offer a claim check tool where you can input your claims data and it will return results indicating covered or non-covered with some kind of rationale for why it's not covered. When you're really lucky, they'll link right to the policy that drives the decision.