Wiki Denial of code 22614 based on LCD L39788

[Sica2010]

I work for orthopedic surgeon that specializes in the spine. So my doctors bill spine fusion with additional levels often. The way the AMA defines code 22614 as an add-on code it can be billed with 22600- cervical, 22610- thoracic, or 22612- lumbar. The local Medicare administrator (WPS) has an LCD(L39788) for cervical spine fusion that came into effect in July 2024. They list code 22614 as medically appropriate if medical necessity is met, that makes sense for cervical spine fusion. But WPS is using that LCD to deny CPT code 22614 for lumbar and thoracic spine fusion. Has anyone else had same denials?

 

[Pattylavin09]

Hi, we are having the same denial for thoracic and lumbar. I work for few neurosurgeons.

 

[Sica2010]

Thank you. It's nice to know others are dealing with this. Are you submitting redeterminations too?

 

[crtatum]

Hello, I am having the same issue with Medicare for the lumbar diagnosis for 22614 and 22585. I have had to appeal every single case. Still waiting for the outcome. They need a new LCD update to resolve this issue it is a huge inconvenience for the billers and the providers...

 

[mbirch@unclinic.com]

Getting the same denial for thoracic and lumbar. My first appeals are denied, I'm going to submit to QIC