Insurance Specific CPT

cways715

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Hello....we have come up with quite a dilemna with one of our insurance carriers.

We billed CPT code V5261 which is recognized by every payor for Hearing Aids; however, when we billed SmartHealth they denied the code stating that we needed to bill with a valid SmartHealth Code. When we called SmartHealth we were told by the insurance company to bill CPT HA001.

My concern is that I always thought that we had to bill per AMA or CMS guidelines. Is this appropriate coding??????

Thanks in advance for your help. :confused:
 

JMeggett

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Spokane Valley, WA
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Hello....we have come up with quite a dilemna with one of our insurance carriers.

We billed CPT code V5261 which is recognized by every payor for Hearing Aids; however, when we billed SmartHealth they denied the code stating that we needed to bill with a valid SmartHealth Code. When we called SmartHealth we were told by the insurance company to bill CPT HA001.

My concern is that I always thought that we had to bill per AMA or CMS guidelines. Is this appropriate coding??????

Thanks in advance for your help. :confused:
I know this seems and feels wrong, but if an insurance carrier is telling you what code to use so that an item will be reimbursed, it is ok to follow their specific guideline and bill it that way. Alot of carriers don't go by CMS guidelines. If it were a bigger thing, like surgery codes or even office coding and they were telling you to use codes that aren't accurate, then I would want a Provider Rep/Advocate from the carrier to confirm to me WHY they want something different than what CPT guidelines say.
Jenna
 

cways715

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Thank you very much for your help. I was leaning towards that it was okay, but just wanted to check.

Have a great day.
 
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