Wiki CPT 25448 Denials

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Cassi3434

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Appleton, WI
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Can anyone provide tips on getting the new CPT 25448 reimbursed? We are getting payment from Medicare and plans that follow a percent of Medicare, however, we are not receiving any payment on our other contracts. We have submitted reconsiderations with the operative report, but they are stating it is not on their fee schedule to pay. I've reached out to our ACO but haven't heard anything back. Is there anything else we should be doing?
 
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It's a new code, maybe they are behind the times on updating their systems. If it is not on their fee schedule it means they have not come into 2025 yet. You would need to figure out which carriers and how many. If it is WC, they may be a year behind.
If the claims are for services early in January, it could be that.

Once you figure out the carrier and how many, contact your provider rep.

I have seen where groups may hold claims that contain any new codes for a short time at the beginning of the year to help with this.

Example info: https://providernews.anthem.com/ohio/articles/professional-system-updates-for-2025-23230
 
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