Wiki CPT 78492 Denial

[foflo2012]

Hi, I am trying to figure out Medicare denial of CPT 78492, Dx R07.9? no modifiers, any suggestions?

 

[sls314]

Hi, I am trying to figure out Medicare denial of CPT 78492, Dx R07.9? no modifiers, any suggestions?

If the services were rendered in Texas, Novitas is the MAC.

Novitas has an LCD and a billing and coding article for that service. I would review both of those to make sure that the claim met the LCD criteria for that CPT code.

LCD: https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=35083

LCD Reference Article: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=56423