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Wiki Anthem Medicare denial

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cmills0509

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I work for an allergist. We do allergy shots every day. We got a denial for CPT 95115 (single injection) with ICD 10 J30.1 (allergy to pollen). They said that procedure code does not match or correlate with submitted diagnosis as their denial reason. When I called to speak to a claims rep they read word for word the denial on EOB but couldn't tell me where to look to see that this is valid. I have a hard time finding what I want on cms.gov. Anyone have any ideas where or how to find out if this is a correct denial? We just billed 1 month ago the same way and it was processed and paid. Thanks for all the help.
 
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