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MediCal Payments (Northern California)

Tierni Posted Tue 03rd of September, 2019 13:15:15 PM
Hello. We have always been told MediCal pays a claim with multiple lines at a descending rate. However, I can not find any supporting evidence of this. Example: A claim has two lines. MediCal pays line 1 at 100%, and line 2 at 50%. Do you know if this is true, and if so, where I can find their policy regarding this? If this is true, then it would be safe to assume you'd always put the CPT's in their highest RVU/Pricing order. Thank you for the help!!!
SuperCoder Answered Wed 04th of September, 2019 08:08:30 AM
When billing multiple procedure codes performed on the same day of service on the same patient by the same physician codes should always be listed according to their assigned descending RVUs This sequencing is important when it comes to reimbursement because if a lesser RVU code is billed first it...
Tierni Posted Wed 04th of September, 2019 11:54:49 AM
Thank you for this information. Where did you get this information from? I would like to review myself.
Tierni Posted Wed 04th of September, 2019 13:13:25 PM
Please Note: I'm not questioning the modifier information. I want to see supporting documentation on the payment breakdown you provided. Thank you.
SuperCoder Answered Thu 05th of September, 2019 04:15:14 AM
Hi Tierni Hope you are keeping good We encourage discussion to enhances the knowledge which impart lifelong So do not hesitate to ask any related question Well you can find the related information related to modifier on the SuperCoder's modifier detail page On this page you can refer Lay Term...

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