Wiki NEW EMG code 95886 denials

[deborahcook4040]

is anyone else getting modifier 26 denials on these?

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Medicare states that "Procedure modifier was invalid on the date of service" for CPT code 95886 billed with a modifier 26 (done in a facility outpatient setting), with 2 units. NCS codes were billed as primary procedures. Any idea why these might be denying? I've received several denials for these. Maybe I shouldn't use the 26 modifier because it's an add-on code? But we still don't own the equipment, so isn't a 26 modifier required?

 

[ssampor@yahoo.com]

I have been getting denials too but not for the modifer and they are separating to expedite handling. So now they will have the NCS on a different EOB.. But my denial states incomplete/invalid from dates of service. Little Frustrated...

 

[lizzardb]

I spoke to a Medicare representative from our jurisdiction (Alabama) who said that only 1 unit of 95886 could be billed per line. More than one unit could be billed, but only 1 per line.

I hope that helps.

 

[valerie75501]

95886

Yes, I am getting denials as well. I have been on several different sites trying to find an answer. Someone suggested the following.

95886 -26
95886 -59 -26

I have just billed a couple out like that. I will respond again as soon as I have denial or reimbursement.

Val Johnson, CPC
Practical Billing Solutions, PA

 

[deborahcook4040]

well... they paid part of it.

Billing with 95886,26x2 got completely denied.
billing with 95886,26 and 95886,26,59 got the one with the 59 modifier paid, but the one without the 59 was denied. I rebilled with it 59s on both, which seems inappropriate to me, but whatever makes Medicare happy makes ME happy . Incidentally, I checked with the facility and they're getting paid for thier portion with no problems. I find that frustrating.

 

[tdml97@yahoo.com]

95886

Well, we don't split bill our EMG's but I have gotten this paid qty x 2 by Medicare MI

Have found out that if you bill a 95885 & 95886 - you need mod 59 on 95885