Wiki Insuarnce Denying Implants due to HCPCS

[bbwixler]

The insurance company has been denying the implant "OPTIMESH 1500E-25MM" as well as the other thousands of dollars in implants for this case. They are stating that they need a more descriptive HCPCS code. I have attempted to find the answer everywhere, including the company we purchased thye implants from. I am unable to find this code. The implants for this procedure are over $40,000. PLEASE HELP!!!!! The info i have to work with is as follows:

Optimesh implant 1500E 25mm (bone graft?) - Spineology
Pheonix Cannulated Modular Bone Screw 6.5MMX45MM - Orthofix
Pheonix XRS Open Assembly Standard - Orthofix
AFT Diverted Tube Transplant foundation- Spineology
AFT Straight Tube- Spineology

 

[Kevinph84]

A lot of the stuff you are wanting to report sounds like supplies. I am unfamiliar with the products but you can try to contact the vendor for further information via their reimbursement hotline.

For the bone screw, I would recommend C1713.

Most insurance companies only pay for implants seperately. A few pay for extraordinary supplies (reported typically 99070 or A4649). That all depends on your individual contracts. Watch out for HCPCS carve outs and revenue code exclusions. If there any carve outs and exclusions, you will only get paid for what is listed.

Medicare, and those that follow their few schedule, bundle the cost of supplies into the payment for the procedure.

I hope this helps somewhat.

 

[bbwixler]

Thank you for your response. The Implants were billed as one line item L8699 for all ....i just listed all impants used. Problem is the facility was out of network at the time of service.
The insurance company denied asking for a different HCPCS code. I attempted to contact the Vendor but they stated that they were unable to give out the HCPCS codes saying it is illegal, which i find to be silly since when reps sell products, they usually advise which HCPCS code to use. I am at a loss with this particular situation.