Posting Office Charges

  1. Hills Physicians
  2. United Health Care
  3. Health Plan of San Joaquin
  4. Medicare
  5. Medi-cal CCS
  6. Straight Medi-cal
  7. Blue Cross
  8. Cigna
  9. Partnership health plan
  10. Blue Shield PPO/EPO
  11. California Health & Wellness
  12. Dignity / Western Health Advantage
  13. Tricare (PPO) / Health Net Medi-cal
  14. Sutter Select / SHP / SIP / SutterMedicalGroup
  15. Nivano
  16. Imperial
  17. River City
  18. Aetna
  19. HealthNet Sequoia
  20. Prime Community
  21. Common Rules/Coding tips

For Commonly asked questions please review the following article regarding Billing rules.

- Posting charges Step by step:

Locate the Workqueue list > Select "Charge Review" > Double click "SCC ALL RULES" > Filter the charges to your preference and double click the charge to begin > Fill out the Encounter detilas, diagnosis details, and Charges according to the insurance type, chart notes provided and services completed.

To Add a "REPORT ATTACHED" comment, Select the the CPT code being charged on Line1 > and Select the "procedure comment" option. (see the images attached below)

1.Hills Physicians HMO/PPO/Medi-cal

  • No Authorization is required.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.
  • (IF it is Hill's Physicians Medi-cal see the notes that follow)
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

2.United HealthCare

  • Authorization sometimes required. (Verify on superbill)
  • Always need a primary Care Physician.
  • New consultation codes 99203 and below only.
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.
  • If the only 2 congenital DX codes are either Q22.2 or Q22.8 downcode the echo to 93306.
  • Always print claims and mail them with a report attached.

3.Health plan of San Joaquin

  • Authorization is ALWAYS required.
  • Always need a primary Care Physician.
  • Old consultation codes (i.e. 99245, 99244, 99243)
  • Only use Modifier 25 & 59 when required, do not use any other modifiers for HPSJ.
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

4.Medicare

  • No Authorization is required.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.

5.Medi-Cal CCS

  • SAR# is always required (Auth always req.)
  • Only add referring/PCP if the SAR# belongs to someone else, (the physician attached to the SAR), otherwise remove the referring provider if the servicing provider owns the SAR or if it is an 02 SAR.
  • Old consultation codes (i.e. 99245, 99244, 99243)
  • First 2 DX must be congenital, avoid using "Z" codes.
  • Only use Modifier 25 when required, do not use any other modifiers for CCS.
  • Check if a follow up is required.
  • All CCS charges must be billed with the report attached.

6.Straight Medi-cal

  • No Authorization is required.
  • Always need a primary Care Physician.
  • Old consultation codes (i.e. 99245, 99244, 99243).
  • Only use Modifier 25 & 59 when required, do not use any other modifiers for Medi-cal.
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

7.Anthem Blue Cross PPO/ HMO / Medi-cal

  • No Authorization is required for B.C. M-Cal, But ALWAYS check Aim for Auths If it is a PPO, HMO, and EPO plan.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.
  • (IF it is BlueCross Medi-cal see the notes that follow).
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

8.Cigna

  • No Authorization is required.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.
  • Need to print claims and send them with the report attached. ADD "REPORT ATTACHED" to line 1.

9.Partnership Health Plan

  • Authorization is SOMETIMES required. Always verify.
  • Always need a primary Care Physician.
  • Old consultation codes (i.e. 99245, 99244, 99243)
  • Only use Modifier 25 & 59 when required, do not use any other modifiers for Partnership.
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

10.Blue Shield PPO/EPO/HMO

  • Authorization is SOMETIMES required. Always verify.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.

11.California Health and Wellness

  • Authorization is not required.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

12.Dignity / Western Health Advantage

  • Authorization is ALWAYS required.
  • Always need a primary Care Physician.
  • Old consultation codes (i.e. 99245, 99244, 99243)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.
  • Always print the claim, no need to attach the report.

13.Tricare (PPO) / Health Net Medi-cal

  • Authorization is SOMETIMES required. Always verify.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required. / DON'T HAND WRITE ON THE CLAIMS - ONLY SIGNATURE.
  • (IF it is HealthNet Medi-cal see the notes that follow)
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

14.Sutter Select / SHP / SIP / SMGroup & (Gould)

  • Authorization is only required for *Sutter Gould*
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.
  • (Sutter select iD# starts with a "Y", Sutter health plus starts with an "M".)

15.Nivano

  • Authorization is ALWAYS required.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

16.Imperial

  • Authorization is ALWAYS required.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59)
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

17.River City

  • Authorization is ALWAYS required.
  • Always need a primary Care Physician.
  • Old consultation codes (i.e. 99245, 99244, 99243)
  • Only use Modifier 25 & 59 when required, do not use any other modifiers for River city.
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

18.Aetna

  • Authorization is not required.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59),
  • Check if a follow up is required.
  • (IF it is Aetna Medi-cal see the notes that follow).
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

19.HealthNet Sequoia

  • Authorization is ALWAYS required.
  • Always need a primary Care Physician.
  • Old consultation codes (i.e. 99245, 99244, 99243)
  • All appropriate modifiers required. (i.e. 25, 51, 59),
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached.

20.Prime Community

  • Authorization is ALWAYS required.
  • Always need a primary Care Physician.
  • New consultation codes (i.e. 99205, 99204, 99203)
  • All appropriate modifiers required. (i.e. 25, 51, 59),
  • Check if a follow up is required.
  • IF: The claim has a congenital DX with high severity we MUST request a CCS SAR.
  • IF: The claim has a congenital DX with low severity we MUST submit the claim with report attached

21.Common Rules and Coding tips:

-If there are no congenital Diagnosis codes remember to downcode the echo from 93303 + Dopplers to the single code 93306.

-Use The "Shift"+"F4" keys together to delete lines.

-When billing a for a Fetal visit, Confirm all of the following details before posting the charge:

is it a first time visit? Yes: code,76825,76827,93325 No: For F/U code, 76826,76828,93325
Is it a twin or triplet fetal echo?

Twins: add Modifier 59 to the second set of echo codes. (To all 3 lines)

Twin ICD-10 code: O30.009

Triplets: Add modifier 59 to the second and third set of echo codes. (To all 6 lines)

Triplet ICD-10 code: O30.109

**Always add the weeks of Gestation of pregnancy when billing any Fetal Echocardiogram**

-Cash Pay Visit: $500

99205 $150

93000 $82

93303 $150

93320 $ 50

93325 $50

IF the $500 payment was completed as a co-pay and the EKG was not completed. The total will still be rounded to $500. Use exact amounts only when Payment wasn't received on the DOS and only particular services were provided.

Posting SHASTA and GOLDEN VALLEY office charges:

-When posting the consultation, make sure to change "CVD" to "NO".

-Change consult for Shasta visits to $60.00 / For Golden valley $85.00.

-After submitting the claim, the $60 / $85 consultation charge will appear as a self-pay charge.

-Transfer the consultation charge to the correct account. Right click on the consultation code of 60 or 85 dollars. For Shasta send to Acct# 8358540 | For Golden Valley send to Acct# 12053746.

-Remember to invoice for Golden Valley consultation charges!

-Make sure to create an invoice for Shasta and fax it to: 530-245-9075

Be sure to always verify all WARNING messages before selecting submit and Accept.

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