pswain@aelcs.com
New
I am with a laboratory. We have a referring provider ordering G0481 (8-14) drug classes and Humana is denying because post record review they determined the G0481 as not medically necessary, but in their explanation they are telling us the record supports G0480 (1-7) drug classes. Confirmation testing. They are not paying on the G0480, instead denying the G0481 as NMN and pt is not responsible. Can we change the code G0481to G0480 and file a corrected claim based on the carrier's findings and as supported by the medical record? I am afraid that we are going to have to just "eat" the G0481.