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Thread: Medicare

  1. #1
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    Confused Medicare

    I need feedback from anybody who bills Medicare claims for 92014, and 92004, and 92015. The patient is responsibility is the 92015, but when we put on the claim that the patient paid the 92015, Medicare is sending our patients a check, assuming they paid that for the covered services. So therefore we started putting that patient paid 0 even though they paid for the refraction. What is everyone else doing?

  2. #2
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    Are you using the modifier GY on your 92015 code?

  3. #3
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    We use zero paid for 92015.

  4. #4
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    What is the modifier GY? I am familiar with GZ, and GA.

  5. #5
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    GY Modifier:

    Notice of Liability Not Issued, Not Required Under Payer Policy. This modifier is used to obtain a denial on a non covered service. Use this modifier to notify Medicare that you know this service is excluded.

    This seems to be a Durable medical equipment modifier (DMERC). I've had no issues with reporting 92004, 92014 with 92015 using patient paid 0.00 with proper medical diagnosis codes.

  6. #6
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    http://www.corcoranccg.com/Article.aspx?EventID=44 This is a short but helpful article describing why it is always a good idea to use the GY modifier with refractions when filing with MC.

  7. #7
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    I am having a hard time finding info on the DME benefits, on MediCare's website (or any link it will send me to). I am working for a brand new practice (and have been an optician for years, not in the billing department) Now I wear "many hats" and am feeling a little overwhelmed with the world of Post Cat glasses. Can anyone help me find the right direction??? I would love any help I can get........

  8. #8
    OptiWizard
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    Is the check for the 92015 or the other services?

    If it is for the 92015 it probably is NOT from Medicare but from the supplementary. Medicare does not pay refraction. (One of the Medicare HMOs might though).

    Harry

  9. #9
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    https://www.noridianmedicare.com/dme...ive_lenses.pdf This is a great presentation for assistance with Refractive lenses. It gives you a lot of the information you need to know. I have found this website's training and education section to be pretty helpful when I have questions regarding Medicare and post cat glasses in general. Feel free to send me a message when you have questions.

  10. #10
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    Quote Originally Posted by eyecaremindi View Post
    I need feedback from anybody who bills Medicare claims for 92014, and 92004, and 92015. The patient is responsibility is the 92015, but when we put on the claim that the patient paid the 92015, Medicare is sending our patients a check, assuming they paid that for the covered services. So therefore we started putting that patient paid 0 even though they paid for the refraction. What is everyone else doing?
    We had this same issue a couple of years ago. We were told to go ahead and collect payment and post the payment in our system but our claim forms print out with zero paid. It seems to have corrected the issue and we now receive payment rather than payment going to the patient.

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