Wiki How to bill a 97001 to Medicare

[apanda24]

Does anyone have any specific information on how to bill a 97001 to MCR? I can't get any of my 97001's paid by Medicare. I have reviewed the LCD requirements for Texas and am billing accordingly. I am billing with the correct G-code with the correct Impairment Modifier. However, Medicare will not process my claim. I keep getting a denial code of MA130-Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable.

The attachment below reflect a print screen of how the claim is billed.


Any assistance would be GREATLY appreciated!

Amanda Aguirre, CMOM
Texas Orthopedic & Physical Therapy

 

[mhstrauss]

Does anyone have any specific information on how to bill a 97001 to MCR? I can't get any of my 97001's paid by Medicare. I have reviewed the LCD requirements for Texas and am billing accordingly. I am billing with the correct G-code with the correct Impairment Modifier. However, Medicare will not process my claim. I keep getting a denial code of MA130-Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable.

The attachment below reflect a print screen of how the claim is billed.


Any assistance would be GREATLY appreciated!

Amanda Aguirre, CMOM
Texas Orthopedic & Physical Therapy

It's been awhile since I've looked over the "impairment" g-codes, but at first glance, I'm thinking you need more than the 1 that is on the claim. The G8978 is for current status--you one for goal status also. Let me do a little digging, and I'll have a better answer.

 

[mhstrauss]

Yes, that is the problem--you need a goal status also. See the chart on page 4 here:

https://www.cms.gov/outreach-and-ed...k-mln/mlnmattersarticles/downloads/se1307.pdf


HTH!

 

[apanda24]

Thank you!!!!