Wiki Billing 64405 DX M5481 to BCBS Denied

[southsidepain]

We bill 64405 (greater occiptal nerve block) with DX M5481 (occiptal neuralgia) to Blue Cross, they deny stating non-covered. When patient contacts BCBS, they advise patient, denial is due to the diagnosis we are billing. However, M5481 occiptial neuralgia is the reason for the occipital nerve injection.

When we contact BCBS they reference the attached medical policy. Anyone else have this issue?

 

[mhstrauss]

We bill 64405 (greater occiptal nerve block) with DX M5481 (occiptal neuralgia) to Blue Cross, they deny stating non-covered. When patient contacts BCBS, they advise patient, denial is due to the diagnosis we are billing. However, M5481 occiptial neuralgia is the reason for the occipital nerve injection.

When we contact BCBS they reference the attached medical policy. Anyone else have this issue?

The policy clearly states that injection of anesthetic is not covered for Occipital Neuralgia. We have this issue also, very few payers consider this medically necessary. Patient needs to be informed ahead of time so they can decide whether or not they want to pay out of pocket if payer denies.