Question for anyone billing Pain Management procedures in the Novitas JH region with Medicare.
The patient gets Cervical and Thoracic ablations regularly. Instead of switching spinal regions every 6 months to stay within guidelines for 2 covered RF's per region per 12 months (C/T), the patient just completed a BIL CRF on 3/12/24 and is now requesting a BIL THRF to be performed now. Have any of you had luck getting the a Thoracic RF paid after a Cervical was just done? Due to the procedure using the exact same CPT codes I am worried about reimbursement, we will use a Thoracic ICD-10 for the second RF. However, my concern is that Medicare will immediately deny and we take a chance that even after an appeal they will not cover it due to the similar codes being billed and an RF being done in the same specified anatomical region per their guidelines (cervical/thoracic).
Any feedback would be greatly appreciated.
The patient gets Cervical and Thoracic ablations regularly. Instead of switching spinal regions every 6 months to stay within guidelines for 2 covered RF's per region per 12 months (C/T), the patient just completed a BIL CRF on 3/12/24 and is now requesting a BIL THRF to be performed now. Have any of you had luck getting the a Thoracic RF paid after a Cervical was just done? Due to the procedure using the exact same CPT codes I am worried about reimbursement, we will use a Thoracic ICD-10 for the second RF. However, my concern is that Medicare will immediately deny and we take a chance that even after an appeal they will not cover it due to the similar codes being billed and an RF being done in the same specified anatomical region per their guidelines (cervical/thoracic).
Any feedback would be greatly appreciated.