ACADIENTE
New
How do I get an xray with modifier 26 paid...by united healthcare and aetna? All other insurances are paying but uhc and aetna. why is that?
Example...
99203
73030-26
Example...
99203
73030-26
How do I get an xray with modifier 26 paid...by united healthcare and aetna? All other insurances are paying but uhc and aetna. why is that?
Example...
99203
73030-26
What is the denial reason? Where was the X-ray performed? Did your provider perform the official interpretation or is this an overread? Do you have a separate interpretation report?
I order to use the 26 modifier, your provider must perform the official radiology interpretation with a separate report note. This is not a sentence in the progress note. If this was done in say an outpatient facility and the facility billed for the technical and the interpretation then your provider cannot bill with the 26.
Are you sure it isn't bundling to the E/M.
I would try adding a 25 to the E/M on the PA's claim.
You might check with the PA licensing in your state and with your Medicare region. Many do not allow a PA to provide an official radiology interpretation. They are bundling into the E&M. If you have an interpretation report separate from the E&M and if the PA is allowed to provide the official interpretation then appeal with the office note and the interpretation report.
The note you provided is not an official radiology interpretation report. This cannot be a blurb in the office note it must be its own stand alone report.