Wiki 92226 & Wasitng of J0585 (Botox)

[monatuccillo]

Atena is the only one not paying this code. Any suggestion how can I billed this code so I can start getting paid? Most of the time they pay only on the New Pt. Otherwise they deny it saying "Experimental".

My Second Question is if a patient do not show up for Migraine treatment and the meds are prepare can I bill Insurance company for the Wastage of medication J0585?

Thanks,

 

[ardithch]

92226 & Wasting of J0585

Aetna has many of its own policies and they like to deny many codes for experimental. If they have a policy (you can find them on their website) stating they don't cover the procedure, they will not pay, even after appeal.

No, you cannot bill for the wasting of the botox as the injection was not performed.

Hope this helps,

Ardith, CGSC

 

[monatuccillo]

Thank you so much

 

[hopepg]

Agree with the previous post about Aetna often denying for experimental. But, I send numerous reconsideration/appeals to Aetna for claims that have denied for this reason & on occasion get them overturned.
Aetna does have many "blanket" policies on codes or procedures which in turn will apply "blanket" denials on claims billed....but there could be exceptions. If your documentation supports those possible exceptions that could support an overturned denial.

For example, I work in orthopedics & Aetna has a policy on hip scopes but they list exceptions in that policy. I exhaust the reconsideration/appeals process if I know the documentation supports their listed exceptions. Just a suggestion