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Wiki denials for RFA's

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rolltide

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Summerville, GA
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Our office is getting denials from UHC and BCBS on RadioFrequency Ablations. The denial reason states "deemed not proven effective". Is anyone else having this problem? I am at a loss at what to do. Any suggestions will be appreciated.
 
I am not sure what you abalting as it can be used for nerves in the spine and for sleep apnea treatment. These carriers have an LCD that you will need to be sure you meet the medical necessity prior to performing/billing.

Here is UHC's policy for spinal pain:
Policy Number: 2012T0107K

Sleep apnea:
Policy Number: 2012T0525E

I need more information to find specifically what you need for BCBS and what state you are in. Here is an example and you can google and probably find their LCD specific to what was being ablated in your practice.
Anthem BCBS policy:
Subject: Radiofrequency and Pulsed Radiofrequency Ablation of Trigger Point Pain
Policy #: SURG.00125
 
It is for the nerves in the spine. The policy for UHC doesn't give DX codes, but we are following all the guidelines they have and they still deny. This just started at the end of last year, before that we did not have any problems with getting paid.
 
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