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We just started back up with prenatal case management and healthy blue is telling me my modifiers are incorrect. Could someone let me know if they are using the following codes?
Z3201
Face to Face visit- H1001 TS
Telephone or Letter- H1001 TS 52
Refusal- G9012Z3201 is used for pregnancy tests when billing Family Planning patients.
Ours for PCM is:
Risk appraisal Z3490- H1000
Face to Face 009899 – H1001TS
Declined 009899 – G9012
First Visit 009899- H1001
Phone/Letter 009899- H1001TS52Hope this helps!
Brittanywhat is the Z3490 and 009899?
Have you had any issues with Health Blue stating your TS and TS 52 modifier being wrong?
We haven’t done Prenatal Case Management since Managed Care Medicaid started. We were told that the Insurance companies would be taking that over and we could not bill. We do the risk appraisals and bill, but no PCM visits.
DX code O0990
risk appraisal procedure code h1000 $10.00
Initial enrolled h1001 $55.00
Initial non-enroll g9012 $21.40
Home visit H1004 $ 40.00
Face to face H1001 modifier ts $35.00
telephone/letter h1001 modifier ts 52 $15.00Do you have the risk appraisal forms and case management consent forms? If not I can email them to you. Your nurses complete them with the prenatal.
https://dss.mo.gov/mhd/providers/education/health/healthmanual.pdf
Section 10 covers Case Management.
And subscribe to the bulletins to get the most up to date informationHello, would you mind to email the forms to me as well. thank you.
linda.ragsdale@sfchealth.org
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