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Billing 96515 to Commercial Insurance (BCBS)

Latundra Posted Mon 16th of December, 2019 11:10:36 AM
HELP PLEASE!!!!! I billed 96515 with 208 as directed for 96515, but received denial from BCBS stating for exceed units (code underpaid). Did I bill units incorrectly? Pt is receiving 1 injection weekly. Important, please answer within 24 hours.
SuperCoder Answered Tue 17th of December, 2019 03:10:42 AM

Hi,

 

CPT 96515 does not exist. Kndly provide correct CPT code.

 

Thanks

Latundra Posted Tue 17th of December, 2019 09:11:01 AM
The correct code is 95165. I apologize for the error and thanks for the quick response.
SuperCoder Answered Wed 18th of December, 2019 07:25:43 AM

Hi,

 

MUE (Medicare Unlikely Edits) for CPT code 95165 is 30 which means this code can be billed  for 30 unit for a date of service, however MAI is 3 for this code which suggests MACs may pay excess units upon appeal or may bypass the MUE based on documentation of medical necessity.  

You need to check with your payer as well regarding the guidelines related to billing this code for more than 30 units.

 

Hope this helps!

 

Thanks

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