11/21/2023

Healthfirst Denials for 99213-Mod 25 Billed with 11721-Mod 59, 11056

We are having a great deal of trouble with Healthfirst Insurance not reimbursing CPT codes 99213 -25, 11721- 59 modifier. They are only paying for CPT code 11056 or 57. We put in multiple appeals and still not reimbursed. What alternative is there to this disaster. Please inform us.

Most commercial carriers/advantage plans have been and still are denying for bundling of routine foot care services. Though Medicare should be considered the gold standard for determining CCI edits, insurance companies are not always following those guidelines. Until those guidelines are adhered to by all, appeals should be sent with supporting documentation to show that the services should be reimbursed separately. Using the Medicare coding article or redacted EOBs will not substantiate payment.