Wiki CPT codes 99408 & 96127

[aksilvis]

I am getting denial after denial for CPT codes 99408 & 96127. It doesn't matter if it's billed with a wellness code or an E/M code. I have denials from just about all insurances stating "bundled" Does anyone know of a way to get these codes paid? My provider swears that they should be able to be reimbursed separately.

 

[csperoni]

99408 has an N status for Medicare, so it will never be covered. Medicare does have G0396 screening code which is separately payable. Remember that the 15-30 minutes needs to be separate from any time spent on the E/M and would not normally be included in the E/M. For private carriers, you would need to check their policy, but it seems many carriers do not pay separately for this. Some may require -25 or -59/-XU.
These were the top 2 google searches:

https://www.asam.org/docs/default-source/education-docs/sbirt-reimbursement-all-payer-overview_02-20177fa32b9472bc604ca5b7ff000030b21a.pdf?sfvrsn=f41f4bc2_0

https://connectedmind.me/articles/2018/02/26/cpt-99408-cpt-99409-billing-and-usage-guide/

For 96127, Medicare does allow this code $5.05 and I don't see it as a CCI edit for E/M. It does bundle column 2 for Medicare AWE G0438-G0439. Again, private carrier rules vary and it is best to refer to their policy, and may require modifiers.

https://www.aafp.org/fpm/2017/1100/fpm20171100p25.pdf

https://connectedmind.me/articles/2018/12/02/cpt-96127-billing-and-usage-guide/