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.

[shanbull]

No problem. Here is the full policy document on the referring provider requirements for reference: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1305.pdf

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