Medical Billing Forum

Billing => Billing => : Adnare01 July 13, 2018, 12:51:01 PM

: Claim denied with PR 172
: Adnare01 July 13, 2018, 12:51:01 PM

Billing Question!

We keep getting denials on the claims from Medicare Michigan which are billed with CPT code 99358 (Prolonged E&M service) with denial reason as PR-172 (Payment is adjusted when performed/billed by a provider of this specialty). Provider is a Ph.D (Clinical Psychologist). I have no clue to get them paid. Any help would be highly appreciated.

Best Regards,

: Re: Claim denied with PR 172
: kristin July 17, 2018, 01:23:54 AM

Is that code within the scope of practice for your provider? If so, you need to appeal using the guidelines set out by your MAC.