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lcd denial

  1. Z

    Wiki Help Understanding DX Denials for LCD L34616 & A57480- WPS Medicare

    I am a biller trying to determine why certain diagnosis codes were denied under LCD L34616 and Article A57480. Is there a resource where I can check which diagnosis codes can be billed with specific CPT codes? We received these denials for several patients, and while reviewing the LCD directly...
  2. K

    Wiki J0129 Orencia Billing to BCBS Medicare Advantage

    We have several patients at our Rheumatology office that receive Orencia. However, we are having difficulty receiving payment for the drug when billing BCBS Medicare Advantage. We bill J0129 with the JA modifier and as of recent, with the JZ modifier attached as well. Most claims were billed...
  3. G

    Wiki Procedure code 64490 has not met the associated Code-to-Code relationship criteria for CMS ID(s) L34892

    "Per LCD or NCD guidelines, procedure code 64490 has not met the associated Code-to-Code relationship criteria for CMS ID(s) L34892" This is the denial received for an AARP Medicare Complete plan where we billed out: 99214-25 64490-50 DX code M47.812 Can someone explain this denial please? Is...
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