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99358 Florida

David Posted Sat 13th of June, 2015 07:17:54 AM

Can you bill 99358 in Florida? Does this code exist in Florida? If yes, what is the reimbursement for Workers Compensation, Car Accident Cases, Medicare, and Private Insurance?

SuperCoder Answered Mon 15th of June, 2015 04:21:21 AM

Prolonged services without direct face-to-face patient contact, CPT codes 99358 and 99359, are not separately payable and are included in the payment for other billable services.
Remember that Medicare contractors will not pay (nor can you bill the patient ) for prolonged services codes 99358 and 99359, which do not require any direct patient face-to-face contact (e.g., telephone calls). These are Medicare covered services and payment is included in the payment for other billable services.
here's a couple sites with info and other links for more info~
http://www.cms.hhs.gov/MLNMattersArt...ads/MM5972.pdf
http://www.cms.hhs.gov/transmittals/...ds/R1490CP.pdf
http://www.cms.hhs.gov/eRulemaking/d...02215-2232.pdf

David Posted Wed 17th of June, 2015 06:17:11 AM

Can you bill 99358 in Florida? Does this code exist in Florida? If yes, what is the reimbursement?

SuperCoder Answered Thu 18th of June, 2015 10:04:47 AM

Will get back to you ASAP

SuperCoder Answered Thu 18th of June, 2015 10:04:47 AM
Will get back to you ASAP
SuperCoder Answered Mon 22nd of June, 2015 02:54:53 AM

We thank you for your patience.

Yes, code 99358 is valid and reimbursable in Florida. Reimbursement varies from one payer to another, and it's updated every quarter to every year, depending again on the payer. So you need remain updated while billing for a code and DOS plays a very important factor here. Please check with the payer's latest fee schedule information if you already do not have one.

Private insurances have their individual fee schedules and payment rules therefore you need to contact them directly to get the latest information. Each private insurance have their own reimbursement rules. Same goes with car accident cases where payer decides the payment structure depending on various factors.

For Q2, 2015, Medicare payment rate (non-facility) for 99358 in Florida -->

For Fort Lauderdale: $115.22
For Miami, FL --> $119.46
For Rest of Florida --> $110.97

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You will get WC payment rates for Florida here: http://www.myfloridacfo.com/division/wc/pdf/Hospital_Manual.pdf

If payment for 99358 is not available, you need to check with the payer for the same. You can also check the below document though it's a draft copy:

http://www.myfloridacfo.com/Division/WC/pdf/Draft-FL-Health-Care-Provider-Reimbursement-Manual-2015.pdf

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