G0103 Problems

thomas7331

True Blue
Messages
4,136
Best answers
11
Who is the payer and what does the denial say?

It should be covered by Medicare for male patients over 50 years of age once per year. If you're dealing with a different payer, though, the coverage guidelines might not be the same.
 

kathleeng

Guru
Messages
120
Location
Fresno, CA
Best answers
0
There are special guidelines for age and frequency. We have been getting denials from payers with Z12.5, even for patients that meet the criteria. I'm not able to figure out why. Or if there's a different cpt code instead of HCPCS to use that is still a screening and not diagnostic... Denials have been from Medicare, Medi-Cal, Blue Cross, etc.
 
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