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  1. Vaida Posted 3 Year(s) agoRelated Topics

    Florida Medicare all of the sudden started denying 96372 code that were billed with 99212 and J3301 on the same claim with a denial reason: "This service/procedure requires that a qualifying service/procedure be received and covered". I never had any issues getting this 96372 code paid. Has there been some recent changes on billing IM Injections?

  2. SuperCoder Posted 3 Year(s) ago

    Thanks for your question. At this time there is no information regarding changes for billing 96372 to Medicare. Can you provide some additional information so that this can be further researched? What diagnosis was billed with each code and were any other services billed on the same day as this code besides the office visit and drug?

  3. Vaida Posted 3 Year(s) ago

    Thank you so much for your reply. Usually the claims are being billed with diagnosis with diagnosis 695.89 (Granuloma Annulare). The claim has these codes: 99213 mod 25, 96372 and J3301. Everything gets paid except 96372 gets a denial CO-B15, which reads: "This service\procedure requires that a qualifying service\procedure be received and covered".
    As I mentioned before, they get denied by Medicare only. We bill same codes to other insurance companies and they get paid no problem. And Medicare was never an issue to get this code paid until very recent. Thank you in advance for your response.

  4. SuperCoder Posted 3 Year(s) ago

    Thanks for the additional information. There seems to be no reason for this denial. You should call Medicare and ask for clarification on this denial,there may be another issue that is causing these denials. The only other reasoning could be that Medicare wants a diagnosis code that is more specific.

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  • Posted by 82605 Vaida, 3 Year(s) ago. There are 4 posts. The latest reply is from SuperCoder.