Payments > Insurance Payments
92612 FEES
bv7668:
I'm having issues getting my provider paid for 92612 in Kansas for Medicare. The Medicare guide states FEES can be performed by an SLP but every appeal I have sent they send back with just a definition of what a physician is. Has anybody else had this issue or can you give me some pointers to get these paid? Thanks.
PMRNC:
GN Modifier ? http://www.asha.org/practice/reimbursement/medicare/slp_coding_rules/
bv7668:
Thank you. We've tried the GN modifier as well. I've written appeals etc and we never get a response other than the definition of what a physician is. Medicare removed the physician requirement over a year ago.
shanbull:
I found an LCD on this for your jurisdiction and everything you're saying is right (http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33065&ContrId=148).
Are you using the functional limitation reporting codes? And are you including the referral from a PECOS-enrolled MD? Those are the only reasons I can think of for them having an issue with what a physician is, and they are new changes as of this year which might explain why the denials from your contractor aren't very specific.
bv7668:
Thank you. I'll take a look and see what we sent as we have appealed several of these but I like what you had to say about the referral as I'm not sure there was one listed. Thanks again.
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