Wiki 45380 not deemed a `medical necessity'

[CBarry21]

Can some please tell me why the insurance would deny claim for not medical necessity? It is UHC denying this claim.

 

[haraml7]

what is your diagnosis code for this procedure?

 

[CBarry21]

what is your diagnosis code for this procedure?

D12.4 & Z12.11

 

[haraml7]

So if this claim should have been for a screening and turned dx, you would use Z12.11 as primary dx with your appropriate modifier, telling the insurance company that its a screening, and should be processed as a screening. What is the remark code on the remit. There are 2 denial reasons, there is the medical necessity denial, and then your remark code would explain the reason for the medical necessity denial. This may help with fixing this claim. let me know if you need anymore help with this. I am not sure what CPT code you used either, and if a modifier was used, so the medical necessity denial could be for so many reasons.