Wiki Help! CMS and cpt code 76377

[leoraha@yahoo.com]

Hi I was denied payment for code 76377 by Medicaid because they claimed that a code 76377 has a limit of 3x on a claim according to CMS. I have looked in the CPT 2016 code book and the AMA Guidelines but I have not seen any indication of this. I plan on appealing but did anyone hear about a limit of 3x for code 76377 per procedure?

Thanks,
Leorah

 

[danskangel313]

Hi I was denied payment for code 76377 by Medicaid because they claimed that a code 76377 has a limit of 3x on a claim according to CMS. I have looked in the CPT 2016 code book and the AMA Guidelines but I have not seen any indication of this. I plan on appealing but did anyone hear about a limit of 3x for code 76377 per procedure?

Thanks,
Leorah

When I check 76377, it shows an MUE of 2. It also states that you have to report the base imaging code(s) with 76377. On a claim form there are only six procedure lines, so it would be numerically impossible to bill 76377 + each base code more than three times unless you run into multiple pages for your claim.

 

[barbarat]

Medicaid

Unfortunately, you're also dealing with a government agency who, at times, has thrown the guidelines out the window for their reimbursement purposes. Medicaid is a federal program, but is state run. Check your guidelines for your state for exceptions, you will find them on your state's website.

 

[leoraha@yahoo.com]

Thanks Barbara
I will try that.

 

[leoraha@yahoo.com]

Hi Barbara,
I am having trouble finding out any information on the NY State Website. Could you please direct me to the area that talks about code 76377?
Thanks,
Leorah