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Incidental

Vijay Posted Thu 14th of June, 2012 13:56:54 PM

Hi,

We trying to bill CPT 99213 and CPT 99051 together, but insurance denying CPT 99051 as incidental.

Could you please assist as what needs to be done to get paid both the CPT separately..

Thanks & Regards,
Wideangle

SuperCoder Answered Thu 14th of June, 2012 17:42:18 PM

The answer is not easy. You have appeal for the claim with your insurer and ask them if they need something specific to bill this code.Many insurers site 99051’s inclusion in the basic service as a “nonpayment” reason for the special service code. For instance, Blue Cross Blue Shield of North Carolina considers 99051 “incidental to evaluation and management services, surgical services, and laboratory services, and separate reimbursement is not allowed.” Several Medicaid policies have similar policies.

Arkansas Medicaid lists 99051 as a nonpayable code “because the services are covered by another CPT procedure code,” and Maryland Medicaid pays 99051 at $0.00.

One insurer, North Carolina Medicaid, says that 99051 is billable but offers no payment amounts or details. In addition, the AMA does not include an example of the code’s use in CPT Changes 2006.

Vijay Posted Mon 18th of June, 2012 21:09:23 PM

Thanks for the reply!!!

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