CPT 93792/93793 denied by HMSA

[simpham]

I bill 93792/93793 on the same DOS and claim got denied by HMSA. The reason is "We do not recognize a separate charge for this service that is considered integral to the other services being performed."

Should I add any modifier and resubmit the claim to get paid?

[Michele]

You should never "add any modifier to get paid".  The modifier must be warranted and indicated in the patient's notes.  I have to say that because sometimes billers get so caught up with "how do I get the claim/service paid" that they don't realize they are changing the records without knowing if the changes are supported in the patient's notes, which can be construed as fraud.

With that being said, it may be that the 93793 is part of the 93792 and that insurances don't allow them separately.  If it is considered part of the 93792 then no modifier will change that.  If they are truly separate services you can try using the 59 modifier.  The only thing that will tell if it will pay is the rules of the plan.