Author Topic: 98941 Modifier for Advantra Freedom  (Read 3504 times)

dfranklin

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98941 Modifier for Advantra Freedom
« on: December 01, 2009, 05:09:30 AM »
I keep getting rejected for our 98941 with Advantra Freedom First Health Life and Health Insurance.  They state " Service Code is inconsistent with modifier used OR a required modifier is missing".  Other then medicare I did not think a modifier would be needed for this service.  If they are looking for AT can we add this as the billing company to the exist denied claims and resubmit or do we have to go through the Providers office first? 

Is there some other modifier you can think of?  Some of them we submitted 98941 with 98943 modifier 25 and 98941 was not paid (for same reason above) and then 98943 also was not paid stating "Modifier submitted is not appropriate for the code billed".  What modifiers should we use on the following example:

98941  98943  97039  97010  97014  S9090

Thanks~

Don

Michele

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Re: 98941 Modifier for Advantra Freedom
« Reply #1 on: December 01, 2009, 06:58:35 PM »
Advantra Freedom First Health Life and Health Insurance  -  is that a Medicare HMO or Medicare replacement plan?  Many of those require the same modifier as Medicare - AT.  I haven't seen the 98943 covered very much, no matter what modifier is put on.  As for the others, they may require a 59 modifier, but the provider would have to let you know if it was 'distinctly separate' from the other codes.  You can't just add them to get it paid.

Michele
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dfranklin

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Re: 98941 Modifier for Advantra Freedom
« Reply #2 on: December 01, 2009, 09:32:21 PM »
I am not sure. It states it is a Coventry Health Care Plan.  I did see another remark code where it stated "Exceeds Medicare Allowable." So maybe they are a Medicare plan. I guess i will need to call them to find out for sure.

I did see where they paid 98943 with modifier 51.  And they also paid a 98941 with a modifier AT.  I guess I will have to go back to the provider to find out if any of these procedures are where I can add mod 51 to 98943 or AT to 98941.

They also wanted the older code of 97014 instead of the new code of G0283.  When should we use the new code vs the old code? Other carriers aren't paying on the old only the new and vice versa?

Thanks for the help and feedback.  I greatly appreciate it.

Don

Michele

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Re: 98941 Modifier for Advantra Freedom
« Reply #3 on: December 02, 2009, 09:18:22 AM »
We find the same thing, some carriers want one code while others deny it.  You just have to know which carriers require which.  Not that answer we like to hear!

Michele
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dfranklin

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Re: 98941 Modifier for Advantra Freedom
« Reply #4 on: December 02, 2009, 11:05:49 AM »
Do we put that back on to the provider to note on the superbill or is that something we should just know or have like a "hot Sheet" to check for codes/carriers or something?

Michele

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Re: 98941 Modifier for Advantra Freedom
« Reply #5 on: December 03, 2009, 06:46:49 AM »
I usually sit down with my provider and explain the different requirements for each carrier.  Then we come up with a plan.  Most providers do not know what insurance a patient has when they are treating them, so it wouldn't work for them to try to figure out when they need to put "AT" modifier on the superbill and when they don't.  Most of my providers inform me that their treatment is for an acute condition unless they indicate otherwise.  Then it is up to me to know when to apply the AT modifier.  If they cannot say that majority of treatment is acute, I have them check AT on the superbill for the ones that are, and if the billing needs it then we apply it.

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Pay_My_Claims

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Re: 98941 Modifier for Advantra Freedom
« Reply #6 on: December 03, 2009, 09:27:12 AM »
Advantra Freedom First Health Life and Health Insurance  -  is that a Medicare HMO or Medicare replacement plan?  Many of those require the same modifier as Medicare - AT.  I haven't seen the 98943 covered very much, no matter what modifier is put on.  As for the others, they may require a 59 modifier, but the provider would have to let you know if it was 'distinctly separate' from the other codes.  You can't just add them to get it paid.

Michele

it is a medicare replacement plan.....