Wiki 99214 and 76817

[esand12]

We are a group of specialists in reproductive endocrinology. When our patients become pregnant we normally bill 99214 and 76817 with a dx of O09.01 (supervision of pregnancy with history of infertility, first trimester). Recently Highmark has started denying 76817 stating not a covered service when reported with diagnosis. We have reviewed the Highmark policy and used dx codes listed as covered but they are still being denied. Is anyone else having this issue or can anyone offer some advice?

 

[JulieP]

We are also having issues with Highmark lately. Maternal-Fetal specialists seeing denials on 76817, 76811, 76816, and 76805. All denials state the service was not medically necessary or they have reached max benefits for that code. No one from Highmark or BCBS has been able to direct me to a policy which supports these denials.