BCBS denials for duplication on Diabetic shoes

cindyjj

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I am new to the Podiatry billing and have been having difficulties getting our claims paid for Diabetic shoes, CPT A5512 with Modifiers KX, LT, RT & CPT A5500 with Modifiers KX, LT, RT. We usually bill for 2 pairs of shoes and 3 pairs of inserts; therefore, 2 units and 6 units. We have the proper diagnosis code attached to the items. All other Insurance companies don't have a problem with the way we are billing except BCBS. All they can tell me is that the line item is being denied for duplication.

I would appreciate any help that you can give me. I would like to get these paid the first time verse send them in as an appeal with medical notes.

Thank you for your help in this.
 

SienTC1720

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Are you actually billing 2 pairs of shoes, or just 2 shoes? Then it would only be one unit, as they don't pay/bill shoes individually, only by pair. As far as I have ever known, the only insurance that would give out 2 pairs of diabetic shoes per year is Medicaid, and that had to be 6 months apart, never at once. Hope that much helps!
 
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BDBS Denials

I had tried coding the A5512 and 5500 every way I can think, using modifiers KX,RT, LT and even 50 ( per suggestion of BC representative) and have not had any luck. I changed the units biilled to reflect pairs instead of individual items and that didn't seem to work either. BCBS is the only payer that is giving us problems. Has anyone billed this successfully?
 
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