Wiki Medicare 99211

[PamKen]

We have a lot of medicare 99211 claims that are not being paid. Is anyone else having this problem. My clearing house tells me it needs a G code attached and they have been returned to provider. I do not find where a G code is needed for 99211 on the CMS web site. We are an FQHC.

Thank you in advance.

 

[erjones147]

If it's an FQHC, I think you have to add G0467 (for established)

 

[PamKen]

These visits are with our RN and we have tried the G code as well. With no response from Medicare.

 

[mitchellde]

What is the reason for the encounter? Any other codes on the claim? What dx code(s) were assigned ?

 

[ntreber]

if you are an FQHC 99211 is no longer a billable code as it does not require a face to face with the Provider.
our MAC Noridian has billing information for FQHC's that includes all billable "G" codes and what CPT codes qualify as an FQQHC visit.

 

[amys2361]

99211 and FQHC

We are an FQHC as well and CMS states, that a 99211 is not a billable FQHC encounter. Remember it is thought of as encounter not visit. CMS states(if I understood correctly) that it would be reimbursed at the encounter prior to the nurse visit or after the nurse visit. Meaning, it is already paid for.