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biometrics code

Shade Posted Wed 10th of December, 2014 18:23:17 PM

can i use the wellness/ preventative code 99381 to 99387 for a biometrics screening. I used code 96150 with dx. code v72.85 for it and the it is been denied by the insurance claiming that the code was not a preventative code. i was in the impression that wellness code is for annual physical which can only be bill once per year. please help with detail explanation. thank you.

SuperCoder Answered Thu 11th of December, 2014 16:04:16 PM

We are currently researching and will provide a response shortly.

SuperCoder Answered Thu 11th of December, 2014 16:04:16 PM
We are currently researching and will provide a response shortly.
SuperCoder Answered Thu 11th of December, 2014 16:55:42 PM

When billing/coding for Biometric Screening, 99429 should be used. Biometric Screening alone does not support the Preventive Medicine Codes 99381-99387. These codes require much more intensive documentation and are typically only paid once per calendar/benefit year for subscribers.

99499-Unlisted preventive medicine service -The provider performs a preventive medicine service that is not represented by any of the standard and active CPT® codes available.

When reporting a procedure with an unlisted code, submit a cover letter to the insurance explaining the reason for choosing the unlisted code instead of a defined, active code. Include one or more similar codes, and compare your service to those codes to justify the claim amount you are billing. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis, and they will determine payment based on the documentation you provide.

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