Wiki Medicaid, E/M, and Neb Treatments

[dballard2004]

Since Pennsylvania Medicaid plans do not reimburse separately for nebulizer treatments administered in the clinics, would a provider be able to count the time required to administer 1+ treatments in addition to the time for the assessment of the sick visit into the overall E/M level for the encounter? Since Medicaid will never reimburse for these, what is the best way for us to be properly reimbursed for the time/money to administer them to Medicaid patients?

Could we look at a prolonged service code in addtion to the E/M, or am off track here? Thanks.

 

[dballard2004]

Anyone out there bill for Medicaid?

 

[mitchellde]

Is it a written policy by Medicaid in PA that you cannot charge the E&M with a neb or just that it has never been paid. You should be able to bill the ov with a 25 modifier and then the neb. However no you cannot count the time of the neb admin with the patient assessment time because the physician is usually not face to face with the patient during the neb and you cannot substitute codes. But I would look into this with Medicaid a little more as I have always been able to bill Medicaid in other states for both and been paid.

 

[dballard2004]

Thanks Debra! Mediciad in PA does not pay for nebulizer treatments. We can only bill for the E/M (if it applies).

 

[mitchellde]

Is there a rationale they provide for this? A nebulizer is a medically necassary treatment! It just boggles the mind that they have a policy like that. But sadly if that is the case there is nothing you can do except send the patients to the ER when they need this kind of treatment, or write it off.