Wiki Emedny, n.y. Medicaid denying second line items.

[JesseL]

Does anyone else have a problem billing medicaid where it gets denied as below.

99213-25 (Paid)
17110 (denied as bundled)

But if billed as below:
17110 (Paid)
99213-25 (denied as bundled)

They're apparently ignoring modifier 25s now and only paying the first line item... Medicaid didn't really tell me why and to look at the medicaid up date new/bulletin of some sort that I have not found to exist.

 

[CatchTheWind]

Have you tried posting this in the "Payer" forum? Maybe someone there will be familiar with the issue.

 

[JesseL]

Have you tried posting this in the "Payer" forum? Maybe someone there will be familiar with the issue.

Medicaid actually told me they are not paying the second CPT code (office visit & procdure or other way around) since July 2016. They're actually recouping all the payments that they paid now from then.

I told the rep to tell me where does it say that they'll do this in writing. She frustratingly directed me to this article below, which doesn't say anywhere that they're basically ignoring the modifier 25 now..

I'm giving up and just accepting it because when it comes to medicaid there's really nothing you can do about it.

https://www.health.ny.gov/health_care/medicaid/program/update/2016/jul16_mu.pdf