Foot x-ray denial due to many/frequency of service


Miramar, FL
Best answers
Hi everyone,

Our Podiatrist performs foot xray in the office. But we received a denial from Medicare for CPT codes 73600 (LT ankle x-ray), 73630 (LT foot x-ray), 73590 (LT tibia/fibula x-ray) on the same day of service due to "Payment adjusted because the payer deems the information submitted does not support this many/frequency of services". I checked guideline, all three CPTs with maximum unit for single day of service are 3 units, we did not exceed the daily maximum, all CPT were reported with 1 unit on the same day of service.

On the other hand, the same patient has three consecutive office visits DOS 03/24/2017, 04/26/2017 and 05/12/2017 been submitted with all these XRAY CPT (73600, 73630, 73590) and all CPT with 1 unit per visit. And DOS 05/12/2017 has been paid, but for DOS 03/24/2017 is still pending and DOS 04/26/2017 was denied with too many frequencies. By any chance that Medicare is not covering it because procedures have been performed once a month?

Thank you very much for any input!