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Author Topic: Claim denied with PR 172  (Read 8718 times)

Adnare01

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Claim denied with PR 172
« on: July 13, 2018, 12:51:01 PM »
Billing Question!

We keep getting denials on the claims from Medicare Michigan which are billed with CPT code 99358 (Prolonged E&M service) with denial reason as PR-172 (Payment is adjusted when performed/billed by a provider of this specialty). Provider is a Ph.D (Clinical Psychologist). I have no clue to get them paid. Any help would be highly appreciated.

Best Regards,
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kristin

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Re: Claim denied with PR 172
« Reply #1 on: July 17, 2018, 01:23:54 AM »
Is that code within the scope of practice for your provider? If so, you need to appeal using the guidelines set out by your MAC.
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Wentusers

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Re: Claim denied with PR 172
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Wentusers

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Re: Claim denied with PR 172
« Reply #3 on: November 17, 2024, 09:47:19 PM »
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Expekly

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Medical Billing Forum

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« Reply #4 on: May 07, 2025, 01:17:07 PM »
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