bsrinivasarao777
Networker
Hello Everyone,
As per Aetna CPT 64490, 64491, 64492 got denied as experimental,
Upon review of Aetna policy, M47.812 is not a covered DX for the CPT 64490,64491,64492 and M54.2 is a covered DX therefore suggest to replace M47.812 to M54.2 in the diagnosis list and refile this claim.Therefore updated the same information and refiled the corrected claim. Again Aetna denied CPT 64490, 64491, 64492 codes as this service is billable only twice in 3 years time span as per patient plan and patient has already exhausted it. This service last time billed for DOS 091417 and 080416. Checked in EOB found this is not a patient responsibility. Sending to Second level Coding review to see if there are any other options for billing.
In this case, can i look for an appeal or need to review for an adjustment. Kindly advise me. Your help greatly appreciated.
Thanks
As per Aetna CPT 64490, 64491, 64492 got denied as experimental,
Upon review of Aetna policy, M47.812 is not a covered DX for the CPT 64490,64491,64492 and M54.2 is a covered DX therefore suggest to replace M47.812 to M54.2 in the diagnosis list and refile this claim.Therefore updated the same information and refiled the corrected claim. Again Aetna denied CPT 64490, 64491, 64492 codes as this service is billable only twice in 3 years time span as per patient plan and patient has already exhausted it. This service last time billed for DOS 091417 and 080416. Checked in EOB found this is not a patient responsibility. Sending to Second level Coding review to see if there are any other options for billing.
In this case, can i look for an appeal or need to review for an adjustment. Kindly advise me. Your help greatly appreciated.
Thanks