92250,92285

veeramani14

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Hi Everyone, Am getting issues with 92250,92285 codes, frequently am getting denials for these cpt as "Procedure/treatment is deemed experimental/investigational by the payer"

can anyone help me out.?
 

kielee

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Photos...

What is the reasoning behind you doing the photos? Typically we do them once a year for diabetic patients and I never have a problem...What kind out DX's are you billing out for these services?
 

pataw514

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Most frequently 'experimental/investigational/not medically necessary' means that the payor does not deem the procedure medically necessary for the diagnosis code billed. Check your diagnosis and the payor's policy (if any) to see if there is any diagnosis that meets their requirements.
Also remember that 92250 is bundled with 92134.
 
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