Wiki 61559

[mconnolly]

We were denied by Horizon NJ Health saying that this procedure can only be done once is a lifetime. I cannot find anything to that effect. Is it true we can only bill this once, if so, is there another code I can use since our surgeon did do this procedure. This is the only time he did this surgery for this patient, who is a 2 yro baby, I don't think they had it done with a previous surgeon. How do we appeal with insurance?

 

[ChristinaMoore1968]

Horizon BCBSNJ Uniform Medical Policy Manual

I found this in Horizon NJ Health' Medical Policy on their website. You need to log on and review the policy and how it pertains to your particular case.

Horizon BCBSNJ
Uniform Medical Policy Manual Section: D M E
Policy Number: 008
Effective Date: 04/08/2011


Original Policy Date: 06/22/2001
Last Review Date: 07/09/2013
Date Published to Web: 03/07/2011


Subject:
Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses



I hope this was helpful. I alway review the payer's medical policies when I receive denials so that I can compose an appeal.

 

[mconnolly]

Thank you, I will look into that.