Hello,
I code and bill for a pain management facility who performs health assessments using codes: 96103 96120 G0444 and G0396 in addition to office visit.
Per Medicare guidelines we are eligible to perform the service because chronic pain can effect ones mental health.
We always put a 25 mod on the OV, on the assessment codes we have tried putting a 59 mod and on other claims a 25 mod on above listed codes with very little success. (mostly to BCBS IL and Anthem)
The denial always states ‘incorrect mod for procedure’ – if it does deny – sometimes it pays.
Some times they pay and other times they don’t there seems to be no real rhyme or reason to their processing.
I was looking into some options to see if this is payable and I stumbled across mod XU.
I am thinking if I do a 59 and XU mod it could be appropriate and payable.
I code and bill for a pain management facility who performs health assessments using codes: 96103 96120 G0444 and G0396 in addition to office visit.
Per Medicare guidelines we are eligible to perform the service because chronic pain can effect ones mental health.
We always put a 25 mod on the OV, on the assessment codes we have tried putting a 59 mod and on other claims a 25 mod on above listed codes with very little success. (mostly to BCBS IL and Anthem)
The denial always states ‘incorrect mod for procedure’ – if it does deny – sometimes it pays.
Some times they pay and other times they don’t there seems to be no real rhyme or reason to their processing.
I was looking into some options to see if this is payable and I stumbled across mod XU.
I am thinking if I do a 59 and XU mod it could be appropriate and payable.
Has anyone gotten these codes paid?
Does anyone have any thoughts on putting an XU modifier on the health assessment codes performed by pain management?
Any input is appreciated