Denial of 20553 from Medicare

[gr8gal61]

I received a denial from Medicare on an OV 99202, 20553 & J3301 - Medicare denied the 20553 with a reason code these are non covered services because this is not deemed a "medically necessity". DX 733.6 does any one understand this?

 

[slcomstock]

According to the Bulletin LCD #27540 Trigger Point Injections from the Novitas Web site,(Medicare) the following diagnosis are approved for Medical Necessity. If the documentation is there you can use one of the following- 7231., 7239., 724.1, 724.2, 726.19, 729.1. This information is from www. novitas-solutions.com/policy, just find your jurisdiction. I'm not sure if this helps you, depending on where you are from, the diagnosis could be different.

 

[gr8gal61]

According to the Bulletin LCD #27540 Trigger Point Injections from the Novitas Web site,(Medicare) the following diagnosis are approved for Medical Necessity. If the documentation is there you can use one of the following- 7231., 7239., 724.1, 724.2, 726.19, 729.1. This information is from www. novitas-solutions.com/policy, just find your jurisdiction. I'm not sure if this helps you, depending on where you are from, the diagnosis could be different.

Thank you VERY much. Yes it was quite helpful.