Humana denials for Fat Grafting, 20926

lnaschke

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Humana is routinely denying our fat grafting codes we use for breast reconstruction. They state that the diagnoses we use (N65.0, Deformity of reconstructed breast and Z90.13, acquired absense of bilateral breasts and nipples) are not appropriate for this procedure. I have researched this and cannot find anything to support their denial. These are breast cancer patients and Humana's denial is just wrong. Does anyone have any resources I can use for this?
 

Susan

Expert
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Chandler, AZ
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Ask them for their policy on Breast Reconstruction for breast cancer patients. I would research CMS for anything that would support your position. If they don't have a written policy keep fighting... One person can make a difference.
 
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