Wiki 01992 01936 Humana

[CoreMedical]

Good morning,
I am new at Pain Billing. I have a CRNA only group that is charging for the Anethesia on injections. 01991 and 01992 are being billed with a QZ modifier. Humana Medicare is paying, however, the commercial product is not. Charge is being denied as "procedure/treatement is deemed experimental/investigational by the payer. When calls have been placed to Humana, two different representatives have advised if 01936 is billed it would be paid. Can this code be changed (legally)? Has anyone else experienced this denial? Have you appealed and received a positive result?
Thank you

 

[dwaldman]

If one provider is performing the injection. Another such as a CRNA is performing MAC then 01991, 01992, or 01936 can be billed.

Some carriers I believe such Aetna have a memo that states they do not like to pay for anesthesia for pain management procedures.

I believe I heard UHC does not like to pay for 01936.

I would appeal it with the reason it was necessary anesthesia was ordered for the procedure and state in the appeal if they could provide a medical policy that they currently have or further justification to understand the reason for the denial.