Wiki HSG services rendered in ASC

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JessicaTB09

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South Chesterfield, VA
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Hi all, I've been getting denials for HSG CPT 58340 advising that it's non-covered (CO204). This is only for my ASC. This service is rendered for Fertility Testing.
 
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Does the patient's plan cover fertility testing? 204 is explained as "This service/equipment/drug is not covered under the patient's current benefit plan." This leads me to believe there is an exclusion in the patient's plan benefits for this service. Is it commercial insurance or are you billing to Medicare or Medicaid?
 
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CBLENNIE said:
Does the patient's plan cover fertility testing? 204 is explained as "This service/equipment/drug is not covered under the patient's current benefit plan." This leads me to believe there is an exclusion in the patient's plan benefits for this service. Is it commercial insurance or are you billing to Medicare or Medicaid?
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Yes the plans cover fertility testing and treatment. This is for Commercial Independence Blue Cross (IBC)
 
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Our research into our BCBS denials showed they want an infertility dx primary (i.e, N97.1, N97.9, etc) and Z31.41 secondary, if test is being done for diagnostic testing purposes. We are a large fertility company and started getting a lot of denials from BCBS for this same reason starting last year.
 
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ajaykus49 said:
Our research into our BCBS denials showed they want an infertility dx primary (i.e, N97.1, N97.9, etc) and Z31.41 secondary, if test is being done for diagnostic testing purposes. We are a large fertility company and started getting a lot of denials from BCBS for this same reason starting last year.
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Thank you for the insight.
 
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