Sorry for the all-caps… this is straight from the ERA…
09/25/2020 99072 $20.00 $0.00 $20.00
CONTRACTUAL OBLIGATIONS $20.00 THIS PROCEDURE IS NOT PAID SEPARATELY. AT LEAST ONE REMARK CODE MUST BE PROVIDED (MAY BE COMPRISED OF EITHER THE NCPDP REJECT REASON CODE; OR REMITTANCE ADVICE REMARK CODE THAT IS NOT AN ALERT.)
This is the denial remark from Blue Cross (Anthem, in CA). Can anyone explain what the remark code reference means, so I might resubmit these? Thanks!
I am also zero payments for this code. I have submitted it to CareFirst. It is denying because “it is included in the overall episode of care.” Is anybody having any luck with any of the payers?
Actually, I am getting paid by some payors: Blue Shield of CA and Aetna. This remark that I don’t understand is from Blue Cross.
I am sometimes getting paid from commercial insurers (or putting it to patient responsibility) if acute care, not for wellness care. Most are denying as inclusive (and they haven’t increased our overall reimbursement). Vermont Medicaid is paying on some (seems like if they have a respiratory condition code). They have paid sometimes with wellness codes but then putting some of the other usual add on codes (screening for SDH) into a suspend. I take offense that by insurers not paying universally (not paying for wellness visits) they are making a statement that they are fine with putting health care workers at risk. We have to take safety precautions (phone screening, cleaning, PPE) for everyone since we never know which parent/patient may be a carrier.
Aetna, Cigna and Humana are paying on the code. Many others are not.
As of the end of October, many payers (Cigna, UHC, etc) issued statements that the code will not be separately payable. We will be submitting letters to all major commercial payers with a copy of the AAP letter regarding the code, I am unable to attach it here but happy to forward to whomever would like a copy. Hoping if enough of us hassle them, we will see some progress.
I would appreciate a copy of the AAP letter (or link, if that’s easier). Thank you!
Thank you!
Thanks Chip, I did some test cases yesterday with 5 of our insurance plans, this letter will provide ammunition for those that denied.
Thank you so very much!
Any updates on payment for this code? I’m not sure I should keep bothering to include it.