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NST's and Nurse Visits with Wellcare in SC

Michelle Posted Tue 19th of June, 2018 09:45:16 AM
Is anyone having issues with receiving payment for an NST and a nursing visit with Wellcare of SC? We have billed them together with and without a 25 modifier an either way they have started bundling the NST with the office visit. This has not been the case in the past and they seem to be the only insurance bundling these types of claims.
SuperCoder Answered Wed 20th of June, 2018 07:34:52 AM



As per the general coding guidelines, the global period of NST procedure code (59025) is 000, which states: Endoscopic or minor procedure with related preoperative and postoperative relative values on the day of the procedure only included in the fee schedule payment amount; evaluation and management services on the day of the procedure generally not payable. Hence, the nursing visit performed along with NST (non-stress procedure) will not be separately payable.


Note: The dollar value for NST procedure for South Carolina is $45.31; whereas, the dollar value for nursing visit will be comparatively higher than the NST procedure. As per some industry experts; they tend to report an E/M service instead of NST procedure for higher reimbursement. Again, it depends on your payer in your locality.


It is advised to get in touch with your respective payer for reimbursement guidelines for NST and nursing visit performed on the same day.

Michelle Posted Wed 20th of June, 2018 10:45:50 AM
This is not a global nst, it is a fee for service Medicaid. We are not billing it the day of any surgery or in office procedure. All other carriers have no problems paying the NST and nurse visit together.
SuperCoder Answered Thu 21st of June, 2018 06:08:06 AM

As per your statement that all the all other carriers have no problems paying the NST and nurse visit together; so there seems to be some payer specific guideline in your case.


It is advised that you should check with your specific payer for how they would like these services to be reported. Your payer might guide you for the additional documentation that is probably lacking from your side.


Thank you.

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