I need help! I have a specific nursing home that initially refused to pay for a Skilled patient claim with CPT 51798 billed. They sent the claim back to us and stated they are not responsible and to bill Medicare. I even sent the copy of Medicare's denial to the nursing home with the claim.
I called the nursing home and spoke with their billing person and I told them we already billed Medicare and got a denial stating patient is in a nursing home. Then the nursing home billing person said we have to bill the code with modifiers TC and 26. Why would I need to bill Medicare and the nursing home with a modifier? This does not make any sense to me. I have checked the 2019 SNF list found on CMS website and confirmed that CPT 51798 should be billed to the nursing home. I don't have this problem with any of the other nursing homes, just one in particular.
I called the nursing home and spoke with their billing person and I told them we already billed Medicare and got a denial stating patient is in a nursing home. Then the nursing home billing person said we have to bill the code with modifiers TC and 26. Why would I need to bill Medicare and the nursing home with a modifier? This does not make any sense to me. I have checked the 2019 SNF list found on CMS website and confirmed that CPT 51798 should be billed to the nursing home. I don't have this problem with any of the other nursing homes, just one in particular.