Wiki 83036 A1C denial

[mgarcia400]

I work for a Family practice and have been getting denials for 83036 A1C from Medicare and Medicare Plus Blue claims. I am aware that
it's not medically necessary sooner than every 3 months, and we do use the QW modifier. It is being linked to E11.29 as this was done part of an annual wellness. Can anyone please help with this?

 

[thomas7331]

Denials can be for many different reasons and will all be handled differently - can you give a little more information? Is there a particular denial you're getting on these?

 

[SharonCollachi]

It always helps to tell us the exact denial code and description, and what else was billed with it. The answers may change with more information.

Medicare's National Coverage Policy is here.

Have you looked at your Carrier's website to see when the next available date for billing that code will be?

 

[SharonCollachi]

(Thomas hit post about 2 seconds before I did, I think!)

 

[mgarcia400]

The claim denied per LCD/NCD guidelines 109.21. The reasoning is just not very clear to me.