Insurance reimbursed for injection not yearly physical code

One of our insurance companies paid only on the injection service and serum and rejected the annual physical code on a claim. In other words payment made for the $58.00 service and denying the $198.00 service. I remember reading that if only one service is to be paid that the reimbursement must be on the higher service. I've tried to find the article to send to insurance company with appeal but can't find it. I thought it was on of Medicare Guidelines. Can anyone help in directing me to this guideline? Thank you.,

re: Insurance reimbursed for injection not yearly physical code

Did you place modifier 25 on the exam? Both codes are E/M, so they are bundling them. Modifier 25 will take care of this.

re: Insurance reimbursed for injection not yearly physical code

I billed a 99396 (Annual Preventative Medicine) not a E & M code and cannot use a 25 modifier. I know I read in this case the higher cost procedure code should be paid. I'm still trying to find this article with no success.

re: Insurance reimbursed for injection not yearly physical code

99396 is an E&M code. You will find it in the 'Evaluation & Management' section of your CPT® book.