Wiki PT Eval 97161 denying per Molina

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mnuhfer04

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Hey all, Molina continues to deny every physical therapy eval 97161 w/mod GP. The denials all state "Benefit is excluded from benefit plan". Molina is fairly new to us, so is there something that I am missing? All of our other insurances pay for this service. We are located in Western New York. Any insight would be great. Someone mentioned to use modifier 59, but I've never had to use that for the eval, so I am not sure.
Thanks!
 
MandyMW1 said:
Did you find a solution to this? We've been struggling to get Molina WA to pay eval codes as well.
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Hi Mandy, I was told by multiple reps that 97161 was not in their fee schedule and to use 97530...doesn't make sense to me since you HAVE to have an eval before being seen, but that's what I was told.
 
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