tci Part B Insider - 2016 Issue 8

Reader Question: Some Payers May Want Modifier 25 Despite Add-on Nature

Question: United Healthcare recently denied a claim, saying that we should have added modifier 25 to our prolonged service add-on code +99354, which we had reported with 99215 for the same date of service. I was under the belief that add-on codes do not need modifiers and merely need to be reported with a base code. In addition, there doesn’t appear to be any Correct Coding Initiative (CCI) edits barring me from billing these codes together. Can you advise? Supercoder.com subscriber Answer: Although in theory you are correct that add-on codes can only be billed with their...

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