smilingswan
New
I need assistance with billing for a second garment for use with the kneehab unit (E0745). 
Previously, Medicare had covered bi-lateral garments, since they can not be used interchangeably. They have stopped paying for the second garment within a 12 months period stating it is not medically necessary, even if the patient has had bilateral knee surgery.
1. We are trying to bill these second garments as private pay items, with a signed ABN. The problem is that most patients are selecting option 2, which means we have to bill Medicare, which we do with a GA modifier. We then get a variety of CO denials ranging from "frequency of service" (a CO151 on both garments when billed together on the same DOS and claim. The patient has no history of any other garments) to "missing indication of whether the patient owns the equipment that requires the part or supply" (CO16, when billed on a separate claim but with the same DOS as the first garment and kneehab unit, neither of which have processed yet). I'm not sure how to get the second item to deny with a PR denial so that I can transfer the balance to the patient.
2. We have been billing these (without my knowledge) with different charge amounts. Garment 1 has been billing to Medicare at $120.00, and garment 2 at $400.00. This doesn't sound correct to me, so I'm hoping someone can clarify this, and, if possible, direct me to a Medicare guideline I can print for my manager.
Thanks so much!
Previously, Medicare had covered bi-lateral garments, since they can not be used interchangeably. They have stopped paying for the second garment within a 12 months period stating it is not medically necessary, even if the patient has had bilateral knee surgery.
1. We are trying to bill these second garments as private pay items, with a signed ABN. The problem is that most patients are selecting option 2, which means we have to bill Medicare, which we do with a GA modifier. We then get a variety of CO denials ranging from "frequency of service" (a CO151 on both garments when billed together on the same DOS and claim. The patient has no history of any other garments) to "missing indication of whether the patient owns the equipment that requires the part or supply" (CO16, when billed on a separate claim but with the same DOS as the first garment and kneehab unit, neither of which have processed yet). I'm not sure how to get the second item to deny with a PR denial so that I can transfer the balance to the patient.
2. We have been billing these (without my knowledge) with different charge amounts. Garment 1 has been billing to Medicare at $120.00, and garment 2 at $400.00. This doesn't sound correct to me, so I'm hoping someone can clarify this, and, if possible, direct me to a Medicare guideline I can print for my manager.
Thanks so much!