Wiki Medicare denying 96375

[ljackson1]

Im getting denials from Medicare for CPT Code 96375. They are stating that it is an unbillable code. I made sure the claim had the proper Initial Code, but it still is denying. Any insight would be great. Also, i know this code is Modifier 59 exempt, but i found a claim that paid this code that had modifier 59 on it. So that makes absolutely no sense! Not sure if it was added by the coder or initial biller. Please help!

 

[stephne_smth]

That code has been replaced if Im not mistaken which is why that code is not billable.

 

[tracyhelget]

We have seen denials for this also. It is an add-on that should be billed with 96365, 96374, 96409, or 96413. Be sure you have one of these primary codes on the charge ticket.

It is possible that Medicare is splitting your charges, so the add-on code is not showing on the same ticket as the primary code. Call Medicare to look into this.

Tracy

 

[ljackson1]

I do have 96365 as the inital. I will give medicare another call to verify if the charges were possibly split. I do appreciate your help.

Thanks.