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medicare E&M billing question

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MBP:
this may be a stupid question.. does medicare have various coverage plans within plan A and plan B? i just received an RA with a rejection for 99205 saying non-covered charges.. i always thought there was only plan A and plan B and benefits for all people covered by those plans were same..

Michele:
There is Medicare Part A & Part B.  Part A is for facility fees, Part B is for professional fees.  There must be another denial code on the eob stating the reason that the 99205 is not a covered service.

Michele

Pay_My_Claims:
http://www.arkmedicare.com/provider/viewarticle.aspx?articleid=6947


http://www.acpinternist.org/archives/2000/05/prevention.htm

MBP:
thank you Michele and Charlene, i figured switching from consultation codes to new patient ones will not be that easy... all the instructions i have read said go for new patient office codes so i dont get it - why the denials now? what should i do now? appeal it? it was for the consult that would have been billed as 99245..

Michele:
If the patient is not a new patient to your office you need to use established patient code.  If the patient was seen in the past 2 years, Medicare will not allow another new patient visit.

Michele

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