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    Wiki LCD Medicare States it is a NONPAYABLE Shock-Wave Therapy

    Good day all, My office is a Neurology and Pain Management specialty and the physician had me look into Shock-Wave therapy which is the CPT Code 0101T. According to the LCD from Medicare it is deemed experimental and not payable. However, some representative for the company my physician spoke...
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    Wiki Ambulatory Surgical Center what is the fee for physician?

    Good day all, I do not know where to locate where the physician would be paid for services rendered in an ambulatory surgical center? The way I understand it is the Medicare Physician Fee Schedule for facility aka hospital has the the hashtag symbol and that is for hospital would it also mean...
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    Wiki IPPS Payment System is what?

    Good day all, I am in the process of gathering intel for my physician who is wanting to understand what is payable for the procedures he does in a hospital setting and from what I am aware of it would be in the IPPS payment system. I have tried to look for it on the CMS site and found an odd...
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    Wiki EMG and Needles

    Good day, I am so frustrated and have looked on this site and the so called American Academy of Neurology for the answer and I am just not seeing it at all. The patient has G56.02 and we just tested the one arm and it was 5 muscles, hence the 95909. However, I get the response from the...
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    Wiki Modifier 24

    My physician performed an ablation on the patient and it just so happened that the patient got sick and was admitted to the hospital. He saw the patient for neurological issues not pain in the back. Was told to appeal, which i did and was told that I should have applied the modifier 24 on the...
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    Wiki Moderate Sedation in Pain Management Payable?

    Good day, I now have another physician at my office that does anesthesia on the patients and performs the service. My understanding is that I bill out the claim with the modifier 47 on the moderate sedation code, which our office is using the 99152 for the patient. I have tried to research...
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    Wiki BCN Medadvantage Maddness

    Good day everyone, According to BCN Medicare Advantage plan procedures 64493-64494 and 64635-64636 are nonpayable as they are deemed questionable nature procedure based off the Hospital Outptatient Prospective Payment System. This makes no sense to me since we are just an office and are not an...
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    Wiki Fee Schedule for BCBS

    Good day, I am currently in the state of Michigan and BCBS has gone to Availity as the source to check on things, but it is not an easy site to find things. I have tried a few ways to try to get the new fee schedule for July of 2023, but it pulls up old articles from Blue Cross News. The...
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    Wiki 99401 what modifier?

    I am confused and am looking for the correct direction. At our office my physician is billing the office visit code and the 99401 what modifer goes on the 99401? I have seen in other threads to place a 25 on it, but I am confused with that because others are stating to put a 59 on the 99401. My...
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    Wiki Enrollment for Medicare Physician

    I am trying to enroll a physician at our office for Medicare that already is established with Medicare and need to have him assigned payments to our facility. I went to the PECOS site and put in the pplication for us, but the response came back that we could not assign benefits at our office at...
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    Wiki MIPS in Neurology and pain management

    What are the type of MIPS codes is your office using when reporting. Two of the codes they use to use are now null and void because it is maxed out. Our office is a pain management and neurology office.
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    Wiki CPT 64483 What is the issue with modifier?

    I am stumped since the CMS updated the LCD L39054 and my doctor has performed a few of these claims that are getting denied for a modifier. It has the modifier RT for the right side what else am I supposed to do the claim to get them paid because it has a modifier and I cannot get them paid. The...
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    Wiki South Carolina Canceled

    This is ridiculous I cannot go to Denver, which was why I chose Charleston, SC. I cannot afford $275 a night nor can I just join virtually that does not cut the mustard. You are not paying for my flight that I paid for. I am so over paying higher memberships fees every year and not getting my...
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    Wiki 64625 How to bill?

    I am new to pain management billing, so I apologize if it is a simple answer. my physician does a 64625, but what about the other levels that he does? Do I bill for multiple levels with the one code or do I include the 64640 for the additional levels that are done? He does and ablation and...
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    Wiki Pricing for Telemedicine from Medicare

    I have been to the website of Medicare the supposed file they have for COVID-19 pandemic does not work. I cannot locate any information on what the price would be for 99441, 99442, or 99443 the only thing I see is that there is no price is what the CMS site is telling me. Can someone point me in...
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    Wiki Molina Medicaid and Observation

    I am curious to find out if anyone else is having this issue. I have tried to bill for this patient for observation from Molina Medicaid and they keep stating that I need a modifier. I have tried the only one that I know of UD thinking that was possibly it and they still say that it needs a...
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    Wiki 36598 No Payment after

    :confused: In my office we have billed for the services of 36598 however, after this procedure is done and the doctor visits the patient in the hospital again it is denied. We have put modifier 24 on the services, but still were denied. We are stumped as to what we should appended to the other...
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    Wiki EMG's and Medicare Refusing to Pay

    I have been trying for two months now to get Medicare to pay for 95886 and 95910 it was done on both sides. First they refused to tell me anything and said refer to the denial codes. Well it was saying that it needed a HCHPCS modifier. I have tried modifier 50 it was denied. I have tried 59 and...
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    Wiki Railroad Medicare Denying G0283

    Hello Coders! I am lost as to why Railroad Medicare has decided to deny all patients G0283 the EOB just says it was not necessary. I cannot go on the website because the physician has to reestablish that we are an active provider. Any ideas would be appreciated. Confused in MI.
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    Wiki Physical Therapy Medicaid Plans and 97140 and 97530 Denied

    Hello Coders! From all my Medicaid plans are all denying 97530 with 97140. However, I do have the modifier 59 attached to the 97530. They say it is denied because of NCCI edits. I reviewed the NCCI, but it does not look like they changed the rule. Has anyone else come across this problem? I get...
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