Wiki CPT code 85097

[kshope]

Is anyone else having problems getting CPT code 85097 paid by Humana and United Healthcare. I have tried everything and for some reason they will not pay and the ones they did pay, they are coming and getting their money back. Just curious if any other pathologists are having trouble getting this code paid.

They are giving various different denial reasons as well making it even more confusing.

Thanks!

 

[SaundraMoy]

Bundling

Some insurances have denied this for bundling with the 88305 but no such edit exists. NCCI actually directs that if a cell block is created we SHOULD be using the 88305 to bill for the cell block in addition to the 85097. Sometimes a phone call is enough but I have had to send appeals for these. If no other denial reason exists copies of the report showing that we are billing for the cell block with the 88305 is usually enough for them to overturn the denial. I have attached a copy of the Revised edit from 01/01/2017.

Hope that helps.

 

[kshope]

Ok, thank you so much. That atleast gives me a place to start with a conversation with the insurance companies.