Wiki CPT 11042 - 11044

[Heatherc7]

Has anyone seen an increase in Medicare medical necessity denials for CPT 11042 - 11044? If so, do you know why?

Thank you in advance!

 

[amyjph]

It is best to have specific numbers and what years? For example, if you ran a frequency report for 2023 how many times were those codes billed to Medicare and paid or denied, etc. by your practice? If you ran the same report for 2024 what is the result? How many are you talking about? Are they all denied for the same reason? What is the denial reason? Does the ICD-10 match the service, was the coding correct from the start? An increase meaning how many, a few, every single claim, only one patient, straight Medicare only or other payers, etc.? Do you have a new coder that is not coding correctly? Do you have an EMR or EHR issue with the claims going out?

This was updated 1/1/2024: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=58567
Noridian LCD: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=38904

When the new year comes everything has to be checked for changes.