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Wiki 96402 denied for prostate cancer diagnosis

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jball

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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?
 
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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?
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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.
 
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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.
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Is Eligard considered chemotherapy? And it seems odd that they paid for the drug, but not the injection.
 
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