Amanda Posted Fri 17th of November, 2017 15:05:10 PM
My doc does the interpretation for sleep studies done at a couple of hospitals. We do not have any contact with the patients before their tests, he just does the reading part. I have been billing 95806 w/26 modifier and have had no problems until Indiana Anthem Medicaid/HIP recently started denying them for lack of a PA. The hospital will give me the PA# and but Anthem says the PA is only for G0399 and not 95806 but the hospital says they aren't given the option of doing a PA for the 95806. Based on what I have read, it doesn't seem appropriate for us to the G0399 as we are not instructing the patients or giving them the devices, we are strictly reading the results. I would appreciate any help!!
SuperCoder Answered Mon 20th of November, 2017 07:29:18 AM