Wiki G0260 Medicare denial to medical necessity

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daboronda

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Bellingham, WA
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We recently received a denial to medical necessity for this code in our ASC. It was billed with the SG and LT modifiers along with fluoro-77002-59 as instructed in the LCD, which denied to bundled. Has anyone experienced this? Checking to see if anyone has a reason for medical necessity before I call. Thank you!
 
I have been doing research on this as well because we are facing the same problem at our ASC center, we have several claims that have denied due to "LCD Guidelines" But we have followed them exactly as expected with no payment from Medicare Plus Blue... any insight would be appreciated.
 
Me too. G0260-SG, RT was previously denied by Medicare because it was thought to be unnecessary for medical reasons. When I contacted Medicare to learn more about the denial, I was informed that the claim was denied due to the diagnosis M46.1. But we've used this diagnosis before and gotten paid for it. Since the diagnosis does not fall under the category of Group 3 codes, I asked the Medicare representative about it and got confirmation. I'm still looking for more information and solutions, so I'm searching and investigating more. Please inform me if you discover a solution to this problem.
 
Also running into the same problem. According to the LCD that we have pulled, we are clearly following the guidelines provided.. but still denying for LCD? Any help, we will take!!
 
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