BCBS Updates to Billing CPT 99080 & 99499

The Centers for Medicare and Medicaid services are allowed to submit claims with 12 diagnoses in CMS 1500 form.

However, some of the practice management systems will limit the diagnoses to fewer than 12 diagnoses.

If any practice management system limits the number of diagnoses to fewer than 12 and the supplemental claims can be submitted with E&M Codes with $ 0.01 or $0.00 based on whether the system allows it. 

 

Billing and Coding Guidelines

 

The simple question is, how to capture all the diagnosis and billed it out to Florida Blue Insurance?. 

 

Submit a second line item with CPT 99080 other than the first 12 diagnoses. Initially, the BCBS accepted only CPT 99080 for additional diagnoses but now, the BCBS insurance will allow to bill CPT 99499 as well for the additional diagnoses. 

The BCBS can accept a zero-dollar charge ($0.00), or a penny charge ($0.01) if your system does not allow zero-dollar charges. 

 

If the claim is electronic, use frequency code “0.” This code will deny as incidental to the procedure code submitted on the primary claim and no payment will be applied. 

 

Billing with a penny charge needs no reconciliation on the outstanding balance for providers.

Use at least one clinical diagnoses code from the original claim in first position and all other additional ICD 10 CM codes in position 2 to 12. 

 

The billed all the diagnoses must be documented in the medical record and they should be supported as per the CMS guidelines. 

The supplemental claims must be submitted within 180 days from the original E&M services. 

 

If you have a capitated payment arrangement, do not submit date-span claims for office services (Place of Service 11).

The CMS may requires documentation, diagnosis coding, and claims submissions to align to each individual date of service and face-to-face encounter for the review. 

Please do not submit a corrected claim Frequency Type 7 or Type 8. A corrected claim Type 7 tells Florida Blue the original claim was wrong, and a Type 8 claim will void or cancel the original claim.