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Help! CMS and cpt code 76377

L

leoraha@yahoo.com

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Neveh Daniel, Jerusalem District
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
 
leoraha@yahoo.com said:
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
Click to expand...

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.
 
Last edited:
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.
 
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