A gait analysis claim is not always easy and straightforward for podiatrists. In order to ensure a successful claim, you should know the codes, know your carrier’s rules, and know exactly which services your podiatrist provided.
Read this gait analysis billing scenario to losing on your payment when reporting these diagnostic services.
Question: We billed a motion analysis with dynamic plantar measurements (96001) and the doctor’s interpretation and report of the results (96004) to Blue Cross Blue Shield. The carrier denied the claim. We performed the test here at our facility, and the doctor reviewed and interpreted the results. Are we billing the codes incorrectly? Should we append a modifier to 96001?
Answer: No, you are not billing the codes incorrectly. The problem is that Blue Cross Blue Shield considers gait analysis an “investigational procedure” and does not provide coverage for the service. Several other carriers have specific policies in place that state gait analysis is investigational and therefore not covered.
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Good news: Some insurers do cover some or all gait analysis services. Prevent denials and delays on your gait analysis claims by following these three rules:
Rule #1: Learn the Codes
Gait analysis measures and evaluates the walking patterns of patients with gait-related problems such as tripping and joint pain. To study a patient’s gait, a doctor may use one or more of the following methods: video cameras to record a patient’s walking pattern, dynamic electromyography techniques (EMG) to monitor a patient’s muscle activity, and a pedobarograph...
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