Medical Billing Forum

General Category => General Questions => Topic started by: t.cassell on February 05, 2018, 02:28:35 PM

Title: Medicare
Post by: t.cassell on February 05, 2018, 02:28:35 PM
Medicare declined 10061 stating "not medically necessary".  The Dr. billed 99347 (housecall) and 11061.  Can I resubmit claim for just the house call?
Title: Re: Medicare
Post by: Michele on February 07, 2018, 08:12:26 PM
You really need to determine why the 10061 was denied as not medically necessary.  Was it because of the dx code?  If only the 10061 was determined to be not medically necessary then they still would have paid the house call.  There must be more information on the denial.  It's really hard to say without knowing more information.  What dx codes were billed?  What place of service code was used?  Etc.
Title: Re: Medicare
Post by: crystallibby on February 26, 2018, 06:49:27 AM
Here is an excerpt that may help you get an answer to your question.
When a patient is notified in advance that service or item may be denied as not medically necessary, the provider must annotate this information on the claim (for both paper and electronic claims) by reporting the modifier GA (waiver of liability statement on file).