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90966 help

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Mary Ann:
Our physician is billing for home dialysis 90966 for a patient that lives in another state, under another Medicare carrier.  Our carrier denied saying our provider has to enroll as a provider in the patient's home state in order to bill.   Is there a modifier to add, or any other way to get around this?  Thanks

Anand:
I dont think mod would make a difference in this case

Michele:
The provider has to be enrolled in Medicare for the state that the services are being performed in.  So if the provider is in Pennsylvania (near the northern border) and they provide services to a patient who lives in NY and the services are being performed in the patient's home which is in NY, then the provider would have to be a NY Medicare provider and bill NY Medicare.

Michele
 

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