Author Topic: Harvard Pilgrim bundled physical therapy services  (Read 2079 times)

barrie

  • Newbie
  • *
  • Posts: 8
Harvard Pilgrim bundled physical therapy services
« on: May 10, 2012, 10:58:04 AM »
Has anyone dealt with Harvard Pilgrim (in the PHCS network).  We are being told that they bundle 97530 and 97140.  We typically bill 97530 (Therapeutic Activity) with more units.  They are paying 97140 (Manual Therapy)- 1 unit and denying 97530 -3 to 4 units.  We used the 59 modifier for both services.
We have contacted them- we can escalate no higher than first level supervisor.  We have no access to billing or coding, they won't provide a fee schedule, they can't explain why they bundle, they say that they follow medicare guidelines but this is NOT a medicare patient.

Has anyone dealt with this and if so, were you successful in getting paid for each service?

Michele

  • Global Moderator
  • Hero Member
  • *****
  • Posts: 4742
    • Solutions Medical Billing
Re: Harvard Pilgrim bundled physical therapy services
« Reply #1 on: May 13, 2012, 03:44:57 PM »
I'm sorry but I have not ever dealt with them.  However, I would ask if they could point you to what reference they are going by.  In my experience, those codes when billed with a 59 modifier are not bundled by Medicare.  I would just ask if they could point you to a reference.

Sign Up for our FREE Medical Billing Newsletter
Get a 10% discount on Medical Billing Products by using Coupon Code: 10OFF
http://www.solutions-medical-billing.com