Good morning. Our doctors are on call for our local hospital ER to handle more complex facial laceration repairs, as they do not have a Maxillofacial Specialist in house. We handle the ER billing for our doctor's treatment out of our office. The most common CPT codes we bill in this case would be 99284 with a 25 modifier for the exam and 13132 or 13152 for the complex repair. We recently began having an issue with a local Medicaid provider, Keystone First, who are denying the laceration repair codes for a missing modifier. We bill these repair codes on a regular basis to other insurers and have never had to use a modifier on 13132 or 13152. Keystone First used to reimburse us for these codes for years without a modifier. We contacted our rep who stated that they can't tell us how to bill and offered no explanation on what changed, just that a modifier is required on these codes according to CMS guidelines. Again, we bill these codes to Medicare, other Medicaid providers, etc who follow CMS guidelines and have never had to use a modifier on these repair codes. I am completely stumped at this point, any direction or advice would be greatly appreciated. Thank you!
