mnk8383
Contributor
Help Please!!! We are an ortho practice who has our own physical therapy department with one MPT. We keep getting the same denial on all of our claims that are Medicaid only patients stating" Dx or Service invalid for receipient age. Verify MID, dx, procedure code/mod." When I call Medicaid I have spoke w/ 3 different rep's, telling me 3 different answers. I have been told that its a credentialing issue, that they have him listed as a provider type 9 and that I need to call provider enrollment. So when I call provider enrollment, they have no idea what Im talking about and said his credentialing looks fine. Another rep tells me that we can't bill for PT OVER the age of 21 without a modifier. I have never heard of a modifier that defines that we are treating a patient over the age of 21. I've been a coder for almost 5 years but I don't seem to be familiar with a modifier like that and I've looked at the HCPCS book up and down. I am STUCK and Medicaid is absolutely no help AT ALL. I don't know what to do. Our claim looks fine, with billing for the correct cpt's, etc. Does anyone have any suggestions??? ![Confused :confused: :confused:](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)