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Preventive Medicine Codes 99384 & 99394 Modifiers

Oscar Posted Fri 11th of September, 2015 09:38:23 AM

Please answer the following coding question.

1) We have a pt with chief complaint as Sports Physical and did preventive care and my doctor took a CPT code 99384 as patient is new patient with age 15 Years. But, claim got denied saying Modifier is missing and they are suggesting EP modifier something which we are not very sure.

2) We have an established pt with chief complaint as Physical and did preventive care and my doctor took a CPT code 99394 as patient is established patient with age 17 Years. But, claim got denied saying Modifier is missing and they are suggesting EP modifier something which we are not very sure.

Please suggest what is correct modifier we should use with these Preventive Medicine codes 99384 & 99394?
There was no additional E/M workup done on both these cases to use 99201-99215 with 25 modifier. Please suggest.
Thanks

SuperCoder Answered Mon 14th of September, 2015 02:15:10 AM

Please check whether your patient qualifies for EPSDT program (Medicaid early periodic screening diagnosis and treatment). If yes, than you need to use modifier -EP with CPT codes 99381–99385 and 99391–99395.

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