Forum - Questions & Answers

Jan 28th, 2011 - sreshta 45 

Lab & Radiology Interpretations

Hi, I received a denial from Medicaid for CPT® Codes 95810(Polysomnography 4+) and 95811(Polysomnography 4+ w/cpap) stating "Lab and Radiology interpretations are considered part of the professional care of the client". What is this mean? Does Medicaid needs any Medical Records or what? I billed these CPT® codes with modifier 26. Can anybody tell me what does medicaid exactly wants....
Thank You

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Jan 28th, 2011 - jschmutz   323 

95810/95811

95810 and 95811 are mutually exclusive and under no circumstances can they be reported together.

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Jan 28th, 2011 - sreshta 45 

CPT® code 95810,95811

No, we do not do these two procedures on the same day. I have done them on separate dates. Still i got denial from medicaid

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Jan 31st, 2011 - BONNIEP 17 

CPT® code 95810,95811

Check with the lab the performed the studies. They might of billed globally in error and that would make your claims deny. They would have to get the processing of the claims correct before they will consider the TC claims.

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