Medical Billing Forum
Billing => Billing => : BillerJess February 06, 2015, 05:24:49 PM
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Help me to understand what is going on with Medi-Cal...
I'm researching this cpt: 11042 (debridement), also please note I am using Modifier AG to denote primary surgical procedure.
Per the Medi-Cal fee schedule/conversion indicators the allowable should be $37.23. However we seem to be getting reimbursed $83.77 (paying w/RAD 0414 pymt reduced after review)
My concern with this payment comes from us billing a Medi-Cal HMO product who uses the Medi-Cal fee schedule to price claims who has suddenly began pricing this cpt as $0.00. I am now left to appeal these claims, but first I want to ensure I understand exactly how Medi-Cal is getting their allowable.
Any help is appreciated!!
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Just in the event anyone else is searching for this answer, I did find out. The fiscal intermediary prices these based off certain criteria.. so finding one set number is basically impossible. :|