Medicare 99396

[TXBiller]

I received the below on a Medicare physical (99396).  I'm trying to figure out what it means.  Can anyone help me please?

PR-96:  Non-covered charge(s).  This change to be effective 4/1/2007: At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)

N425:  Statutorily excluded service(s).

The electronic return says the patient owes the billed amount but then the billed amount is adjusted.  I'm confused.

TIA

[kristin]

Medicare doesn't pay for physicals using the 99396 code. They cover annual wellness visits, using the appropriate G code. You may want to correct and resubmit the claim, if what the provider did meets the definition of an AWV. The patient does owe the billed amount from the 99396 since that service is statutorily excluded, but I would think twice about charging them for it, if they didn't know it wouldn't be covered, and especially if the issue is that the claim wasn't coded properly by your office.