Question BCBS Denials

sinman0531

Networker
Messages
38
Location
Tampa, FL
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0
I posted this in the derm forum but no one could figure it out, meanwhile, we are still getting denials!


Our practice is located in FL, and FL Blue is denying malignant excision codes (11600-06, 11620-26, and 11640-46) specifically when we are removing basal cell carcinoma. Their denial reason (our 3rd party researched it) is that BCC is not considered malignant "because it very rarely metastasizes". They will still pay for MOHs procedures with a BCC diagnosis. I personally have tried to find a coverage determination doc for it, but only found one article from 2017/2018 talking about skin cancer that gives that reasoning as well, actually almost verbatim to what the 3rd party was told.

Is anyone else experiencing this? Does anyone have any idea where its coming from?
 

Mrsrpc

Contributor
Messages
21
Location
Mooresville, NC
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0
Most of the Blues use Milliman Guidelines, which are proprietary. However, they need to provide you with more information if you make a request in writing (within a certain amount of time of denial-- always watch for deadlines they use as a loophole). Good luck!
 
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