Forum - Questions & Answers
93351 with 93325 Color Flow Doppler to GA Medicaid
We are having an issue with getting GA Medicaid to pay the 93325 when we bill it with 93351. 93351 gets paid but 93325 is denied stating "Add on procedure code not allowed without a paid qualifying primary procedure code. Only use add-on procedure codes when they are paired with a primary procedure code and never as a stand-alone code." We appeal the decision on a DMA-520 but it is also denied. Per coding guidelines 93325 can be billed with 93351 as primary qualifying procedure. They are one the same claim but still deny. We contacted our provider rep but was just told to send an administrative appeal. Is anyone else having this issue? :{
Billing 93351 & 93325 for Georgia Medicaid
Georgia Medicaid has some special payment rules that differ from some of the other payers. You can bill codes appropriately, but whether or not they allow separate payment is another matter, usually related to internal payment policies. If you have their billing manual, it may clarify there about these code pairs. Otherwise, I think their rationale is they will only pay flr 93351. If 93325 is billed, it will be bundled with 93351.