Question 87505 for GA Healthspring

aamipatel

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Edison, NJ
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I am facing lots of denials on 87505 with cigna Healthsring GA location, stating service not medically necessary. any suggestion in this one? Also having issue with Humana medicare for Procedure code 87506. please help me on them as well. thank you.
 

hgreen3

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Tescott, KS
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Im having the same issue. Was hoping I wasn't only one. The medicare policy updated just recently and they removed a TON of prior approved codes for this stool study. I just don't understand
 

danachock

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Brainerd, MN
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I am facing lots of denials on 87505 with cigna Healthsring GA location, stating service not medically necessary. any suggestion in this one? Also having issue with Humana medicare for Procedure code 87506. please help me on them as well. thank you.
Hi aamipatel,
You state that these are happening in the GA location. From my review it appears that Cigna Healthsring is Medicare and Humana Medicare is also. For both procedure 87505 and 87506 in GA both procedures have LCD's again both following Medical Policy #A58710. I would search for the medical policy and validate that what was billed meets medical necessity per Medical Policy. If so, I would appeal.
Thanks,
Dana
 

aamipatel

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Edison, NJ
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Hi aamipatel,
You state that these are happening in the GA location. From my review it appears that Cigna Healthsring is Medicare and Humana Medicare is also. For both procedure 87505 and 87506 in GA both procedures have LCD's again both following Medical Policy #A58710. I would search for the medical policy and validate that what was billed meets medical necessity per Medical Policy. If so, I would appeal.
Thanks,
Dana
Thank you Dana. This information might help, I am already following CMS and Cigna policy guidelines, but surely will look to this LCD policy guideline as well. thanks again for the help.
 
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