Author Topic: Claim denied with PR 172  (Read 83 times)


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Claim denied with PR 172
« on: July 13, 2018, 09:51:01 AM »
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,


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Re: Claim denied with PR 172
« Reply #1 on: July 16, 2018, 10:23:54 PM »
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.