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Wiki 96103 "qualified provider"

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SurgicalAssociates

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We have an LISW in our practice who started doing MBMD tests. The patient takes the test via a computer thus we are billing this as 96103. We have received denials on all Medicare and Medicaid patients. I am certain that the reason for these denials is due to the fact that the provider is an LISW and is not considered qualified by Medicare and Medicaid. Unfortunately this is an on-going battle because the provider is very adamant that she is qualified. I am hoping someone can help me prove me point here - does anyone happen to have anything in writing that states who is considered "qualified" for this CPT code. Thanks so much!
 
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