We are in New Jersey. BCBS Blue card is bundling the E&M code when billed with a pulse ox at the time of a telemed visit paying us only for the pulse ox and not the visit. The patient is seen as a telemed visit for suspected COVID and then is asked to drive to our office and wait in the car to have a pulse ox and COVID swab done. Which modifier should be used for the E&M code since they are denying the modifier 95? BCBS Blue card reps are clueless. Any help would be appreciated.
The same thing has been happening for years in Massachusetts. The E&M code will pay with a Modifier 25 but they still won’t pay for the pulse ox. We have chosen not to bill the pulse ox code since it doesn’t really pay anyway and we spend more reprocessing claims and writing it off.
Tennessee payers do not pay for pulse oximetry. I would not get a pulse oximetry for payment–use it for clinical benefit only.
Most of insurance plans (commercial and medicaid) reimburse separately for E & M and procedure code. Range from $2.60 (single) to upper $9 (for multiple oximetry assessments). Billing E & M with mod 25 and CPT 94760 and 90761 with mod 59. Hope this helps!