We have a client that initially had Medicare Part B in 2024 and is attending our group session procedure code (90853) with diagnosis code (F41.9) and Medicare Part B did reimbursed the claims.
His insurance changed to Aetna in the begining of the year 2025 and they denied reimbursement. Remark code - CO-96: Non-covered charge(s). (This decision was based on a Local Coverage Determination (LCD)
Article - Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520) does not show the code F41.9 in the approved diagnosis list for reimbursement.
The doctor completed an update Psychiatric Evaluation and changed the diagnosis from F41.9 to F41.1 on 06/19/2025.
Can I resubmit corrected claims with proceduce codes 90853 & 90837 from April 2025 to June 18, 2025 with the corrected diagnosis code F41.1 that were denied prior to the updated psychiatric evaluation on 06/19/2025?
I contacted Aetna to find out if I can do that but the agents could not provide an answer. Please can someone help me. I greatly appreately.
His insurance changed to Aetna in the begining of the year 2025 and they denied reimbursement. Remark code - CO-96: Non-covered charge(s). (This decision was based on a Local Coverage Determination (LCD)
Article - Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520) does not show the code F41.9 in the approved diagnosis list for reimbursement.
The doctor completed an update Psychiatric Evaluation and changed the diagnosis from F41.9 to F41.1 on 06/19/2025.
Can I resubmit corrected claims with proceduce codes 90853 & 90837 from April 2025 to June 18, 2025 with the corrected diagnosis code F41.1 that were denied prior to the updated psychiatric evaluation on 06/19/2025?
I contacted Aetna to find out if I can do that but the agents could not provide an answer. Please can someone help me. I greatly appreately.