Wiki Q0091 Not covered by Medicaid?

Create Wiki
M

mauadajar

Guest
Messages
27
Best answers
0
Hi. I am very new to billing. Recently, I just got a claim came back from Medicaid. It stated that Q0091-Procedure not covered by IL Medical Assist, prior approval required.

Is this never covered by Medicaid? If it is, what kind of circumstances pass the approval?

Thank you.
 
Q0091 is a Medicare reimbursed code. If the patient had a pap/pelvic and breast exam, your provider should be billing a preventive code 993XX.
 
For Medicaid pts, you would use S0610 for new pt or S0612 for established pt. And Medicaid does not cover preventive visits for pts over the age of 20.
 
jackiemk said:
For Medicaid pts, you would use S0610 for new pt or S0612 for established pt. And Medicaid does not cover preventive visits for pts over the age of 20.
Click to expand...

Under the ACA this rule should have changed- at least in the state of Arizona they now provide well exams for all patients.

You may need to contact your state Medicaid department for clarification on how to bill well woman exams or paps. Could it have been a diagnosis / HCPC code mismatch?
 
these S codes are not recognized by every state's medicaid program. )Michigan does not recognize these any longer)... You can download your MCD provider manual though and read up on this. Not sure what state you are billling for.
 
Ok, so Medicaid only paid for 99205,25 but did not pay for Q0091 and G0101. It said G0101 was previosly paid.

I also have a similar claim that got the same result. This one was a 99386 with the pap and pelvic/br exam. Again, Medicaid only paid for the preventive visit.

What is you experience on this? Does Medicaid only pay for the visit and not the other things?
 
Ok, I have a resolution for those who are in the same situation. I called Medicaid and rep said that Q0091 can be paid if Pt also has Medicare. G0101 is bundled with the preventive visit. This is the reason why it was not paid.
 
You must log in or register to reply here.
Top