Biller2023
Networker
We have a patient who comes to us every week for an acupunture service and feels better when he get this service. It looks like medicare only covers up to 20 visits in a 11 month rolling period and after the 20th visit they deny all acupuncture services until the next 11 month period begins. We use acupuncture codes 97810 (1 unit) 97811 (2 units) and 97813 (1 unit) 97814 (2 units). From the 12th to the 20th visit, medicare requested to include modifier KX with these codes which we have been doing and we do not have issues getting paid until the 20th visit.
As this patient comes to us every week, how can we make medicare make payments even after the 20th visit. I tried appealing with progress notes showing medical necessity but they have still denied the appeal and sent us the attached letter. Can someone please let me know what add on code we need to use as mentioned on this letter and what we should also mention in the office notes so medicare pays even after the 20th visit. Thank you.
As this patient comes to us every week, how can we make medicare make payments even after the 20th visit. I tried appealing with progress notes showing medical necessity but they have still denied the appeal and sent us the attached letter. Can someone please let me know what add on code we need to use as mentioned on this letter and what we should also mention in the office notes so medicare pays even after the 20th visit. Thank you.