Medical Billing Forum
Payments => Insurance Payments => : bv7668 April 23, 2014, 10:57:17 AM
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I'm having issues getting my provider paid for 92612 in Kansas for Medicare. The Medicare guide states FEES can be performed by an SLP but every appeal I have sent they send back with just a definition of what a physician is. Has anybody else had this issue or can you give me some pointers to get these paid? Thanks.
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GN Modifier ? http://www.asha.org/practice/reimbursement/medicare/slp_coding_rules/
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Thank you. We've tried the GN modifier as well. I've written appeals etc and we never get a response other than the definition of what a physician is. Medicare removed the physician requirement over a year ago.
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I found an LCD on this for your jurisdiction and everything you're saying is right (http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33065&ContrId=148 (http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33065&ContrId=148)).
Are you using the functional limitation reporting codes? And are you including the referral from a PECOS-enrolled MD? Those are the only reasons I can think of for them having an issue with what a physician is, and they are new changes as of this year which might explain why the denials from your contractor aren't very specific.
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Thank you. I'll take a look and see what we sent as we have appealed several of these but I like what you had to say about the referral as I'm not sure there was one listed. Thanks again.
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No problem. Here is the full policy document on the referring provider requirements for reference: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf (http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf)