Wiki 96402 denied for prostate cancer diagnosis

Create Wiki Sort by date
J

jball

New
Messages
6
Location
Oak Brook
Best answers
0
BCBS of IL is denying 96402 when billed for C61, prostate cancer. The denial states "missing/invalid diagnosis or condition". I have found that they are paying J9217 from the drug, but not 96402 and they have the same diagnosis code. I have been unable to locate any policy to explain this. Does anyone know why they are denying prostate cancer treatment FOR prostate cancer?
 
0
jball said:
BCBS of IL is denying 96402 when billed for C61, prostate cancer. The denial states "missing/invalid diagnosis or condition". I have found that they are paying J9217 from the drug, but not 96402 and they have the same diagnosis code. I have been unable to locate any policy to explain this. Does anyone know why they are denying prostate cancer treatment FOR prostate cancer?
Click to expand...

Are you using a Z51 code as primary with the 96402?

It's possible that could be what the payer is looking for - some payers are more picky than others when it comes to the Z code.
 
Last edited:
0
sls314 said:
Are you using a Z51 code as primary with the 96402?

It's possible that could be what the payer is looking for - some payers are more picky than others when it comes to the Z code.
Click to expand...
Is Eligard considered chemotherapy? And it seems odd that they paid for the drug, but not the injection.
 
You must log in or register to reply here.
Top