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

 

[whitneyb162003@yahoo.com]

There is some information missing in order to fully answer the question.

1. Was the denial for the DX or is that just the DX used on the claim?
2. Was this done in POS 11? if not and you are billing the professional, you would need a 26 modifier.
3. Did you bill stress 93016-93018 also?