Wiki Aetna denying G2212 stating this is an add on code

[Biller2023]

We billed 99215 and G2212 (Prolonged out patient office visit) to Aetna (since provider spent more than 55 minutes) but they paid for 99215 and denied G2212 stating "This claim is being denied for one of two reasons: - We did not receive a claim for the primary service performed. Add-on codes are always performed with a primary procedure. Please resubmit this claim with the primary service performed. - The add-on code is not eligible because the appropriate primary procedure/service has been denied. [856]".
Medicare pays for G2212 but Aetna is not paying. Should we use 99417 instead?

 

[sls314]

We billed 99215 and G2212 (Prolonged out patient office visit) to Aetna (since provider spent more than 55 minutes) but they paid for 99215 and denied G2212 stating "This claim is being denied for one of two reasons: - We did not receive a claim for the primary service performed. Add-on codes are always performed with a primary procedure. Please resubmit this claim with the primary service performed. - The add-on code is not eligible because the appropriate primary procedure/service has been denied. [856]".
Medicare pays for G2212 but Aetna is not paying. Should we use 99417 instead?

The denial reason makes me curious - did they pay you correctly for a 99215, or did they downcode it to a level 4?

 

[Biller2023]

They paid for 99215 they didn't downcode to level 4

 

[sls314]

They paid for 99215 they didn't downcode to level 4

Ah, okay. It was just a thought, given the odd phrasing of the denial.

I think Aetna Medicare recognizes G2212 for Medicare patients. I might try appealing it with records showing that there was a 90 minute or more visit documented.

I have billed G2212 to Aetna, but the payments don't get routed back to me unless there's a coding denial. I'm not sure if they are actually paying on it or not - I'd have to find an example and go look to see what happened with the claim.