Can someone help? We are billing Medicare the 93015 in an area that recently became HPSA and the code is now being denied as an "unprocessable" code. Only the professional component of this service qualifies for the bonus payment. Medicare wants us to rebill the claims. This leads me to believe we have to bill 93016 and 93018 (PC). Can anyone confirm this? Should we bill all three codes? 93016,93017,93018.
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Wiki HPSA and 93015
- Thread starter aalmeida
- Start date
Samantha.Prince
Networker
Best guess
I haven't coded cardiovascular stress tests for Medicare before but wouldn't billing all three codes be unbundleing of the 93015? What is the Medicare denial code?
I haven't coded cardiovascular stress tests for Medicare before but wouldn't billing all three codes be unbundleing of the 93015? What is the Medicare denial code?
Yes it is unbundling the code, but since the practice is located in a HPSA, Medicare needs to determine how to pay the bonus. The bonus is only paid to the PC part of the code. Since the Drs perform the complete test, I believe we have to rebill these as 93016,93017,93018 instead of the 93015 as this code will not pay when in an HPSA. Does anyone have experience with this? I would appreciate a response.