Wiki G0283 to Horizon

[Biller2023]

We submitted 98926 (OMT) + G0283 to Horizon but they only allowed $52 for the entire claim. Upon speaking with a rep, she stated the capped amount for physical therapy visit is only $52 and since G0283 is a physical therapy code, they allowed only $52 for the entire claim. Is there a way to have Horizon pay for both of these codes or are there any replacement codes. Any suggestions?

 

[mattie7632]

G0283 is the Medicare code for 97014 -EMS. Some BCBS plans do require the Medicare codes and modifiers for PT; however, so you'd have to be sure what Horizon wants first. Also, 97014/G0283 reimburses very little ($5-$10) so keep in mind even if you are successful having the claim corrected using 97014, it might not reimburse much more than that $52 for the entire visit.