Wiki NC Medicaid and CPE with sick visit

[lcanady]

Help!!! I have some denials of physicals that were billed on the same date of service as a sick visit. Does anyone know if Medicaid will pay for the physical, even if the correct modifiers are used? Thanks in advance.

 

[ajs]

Help!!! I have some denials of physicals that were billed on the same date of service as a sick visit. Does anyone know if Medicaid will pay for the physical, even if the correct modifiers are used? Thanks in advance.

Most state medicaid plans do not cover routine physical exams, except for children. You would need to check the website for your state Medicaid carrier for information on specific coverage issues.

 

[smobleybraun]

NC Medicaid should pay for both the PE and sick visit as long as you follow the plan's particular requirements and appropriate modifiers. Example: the FP Waiver will allow for a PE, but not a problem visit for say, strep throat.