Billing > Billing

INSURANCE NOT PAYING FOR PEAK FLOWS

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tanzeem:
Hi,

Can you please help me with the following:
If I bill 94760 95044 and 99214 , insurance does not pay for 94760.
same is the case with S8110.
And even if i bill for allergy inj 95117 s8110 94150 , insurance pays only for 95117 and not the other two. i use modifier 59 with 94150. Do i need to use any other modifier to get them paid or please give me any other advise.

Thanks.

Michele:
What are they being denied for?

tanzeem:
Some insurance say it is a provider discount, some say they cannot pay for these additional charges, and some say since the plan is PPo they cannot pay for it. The Doctor does not charge the patients for these peak flows if the insurance is paying them. I want some advise if I can do something so that the insurance pays them, coz otherwise we simply have to write those charges off. 

Michele:
The first thing I must say is that you shouldn't be adding a modifier just to get a claim paid.  If a modifier helps to describe the services that were provided more accurately then it should be used.  However, the reasons that you are saying they are denied for, it doesn't sound like a modifier would make much difference.  It sounds more like they are not covered charges under the patient's plan then it does that they are being bundled.

tanzeem:
Thanks for your reply. We donot use a modifier unless the service is actually provided but some insurances do pay for the peak flows.

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