Medical Billing Forum

Billing => Billing => : TXBiller March 13, 2020, 09:52:39 PM

: Medicare / BCBS of TX
: TXBiller March 13, 2020, 09:52:39 PM

I have received several of these back and I'm not sure why they are returning unpaid.

On the OV (99214) Medicare is saying CO-B15 (Payment adjusted because this service/procedure requires that a qualifying service/procedure be received and covered.  The qualifying other service/procedure has not been received/adjudicated).  Also saying on this one, M80 (Not covered when performed during the same session/date as a previously processed service for the patient.

On this same claim is 36415, 94010 and G8483

Any ideas why this has started happening all the sudden to us?

Thank you in advance

: Re: Medicare / BCBS of TX
: TXBiller March 15, 2020, 06:30:47 PM

Does anyone know what I’m doing wrong?

: Re: Medicare / BCBS of TX
: Michele March 16, 2020, 11:44:47 AM

Do you have a 25 modifier on the 99214?  I believe the 99214 would be bundled with the 94010 unless it has the 25 modifier indicating it was a separate procedure.  Of course that would only be if the 25 modifier is warranted by the notes.