Linda. Posted Wed 20th of February, 2013 18:21:18 PM
we are performing nuclear stress tests in our office and billing out 93015,78452,A9500x2 .. medicare is finally processing ones done in 2013 and they have added a 51 modifier on the cpt 93015 on all patients. is this correct? and they are paying less stating b/c multiple procedures (co-59)
SuperCoder Answered Wed 20th of February, 2013 19:02:54 PM
93015 and 78452 are both on the list of “Diagnostic Cardiovascular Services Subject to the Multiple Procedure Payment Reduction” at http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R1149OTN.pdf.
The transmittal lists claim adjustment reason code 59 as appropriate for claims where the reduction has been applied. The MPPR for these codes applies to the technical component (including the TC of global codes). You should see full payment for the service with the highest Medicare payment and then 75% payment of the TC for subsequent services).