Wiki Family Planning MCD Help!!

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adaniel

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We have a large adult Medicaid population in our primary care office. Many are seen at follow up visits for multiple dx such as initiation of contraceptive measures and asthma. With dx V25.02 and 493.00, we would bill.....

99213-25 OV
81025 preg test

The patient has regular NC MCD.... not a family planning waiver, but I am getting family planning denials from MCD. I am not billing w/ FP modifier because the patient has regular MCD. I don't understand why this is not being paid!!!

Any insight is greatly appreciated!!!
 
Why are you using a 25 modifier? I have NEVER billed out an office visit and a UA with a 25 on the E/M.
Not sure if that's your issue...
 
I don't use a modifier 25, so that might be part of the problem. For Colorado Medicaid I have to use modifier FP for any type of family planning dx. Otherwise it will deny. Have trI'd sending a couple with FP modifier to see if that works?
 
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