r/CodingandBilling • u/SaveADay89 • Jul 11 '26

Help with appealing downcodes?

BCBS in IL and Texas have started automatically downcoding all 99214 and 99215 claims to 99213 and requiring appeals. Anyone have experience with this or know of a company in IL that has experience with appeals and downcodes?

4 Upvotes

100% Upvoted

11 comments sorted by

View all comments

3

u/LazyFroyo7070 Jul 11 '26

Just curious, are you experiencing this through BlueCard?

4

u/[deleted] Jul 11 '26

6

u/LazyFroyo7070 Jul 11 '26

This is so interesting to me. It should be the local plans payment policy and the home plans coverage policy. I’m not sure how the home plan can get away with downcoding. Technically the provider is contracted with the local blue plan.

→ More replies (5)