Wiki Preventive Visit (99395) denial

[lbuchillon]

Hello everyone

I'm having a bit of a problem, I was told medicaid denied 99395, because the code is for ages 21-39. the patient is 18 and the description of 99395 says ages 18-39.
Has this happened to anyone else? any advice?

Thanks

 

[MarcusM]

Looks like a bad denial that you will need to appeal with a copy of the CPT description from a current CPT manual, AND double check that your patient is Medicaid eligible AND that the exam took place in the correct time frame. At one point, Texas Medicaid would not cover an annual WCC until the month after the birth date unless the date of birth fell on the first of the month. Ex: Boy turns 16 on January 2 was not eligible for his 16 y.o. WCC until Feb. 1.

 

[istanstu]

One of our HMO Medicaids require we use icd code v70.0 the other payers want v20,2