Wiki IV Therapy

[applevalley]

I work in a clinic that has an Urgent Care attached to it. Our clinic physicians order IV antibiotic therapy for patients with complicated infections and the service is provided in the UC setting. For example, they order IV Rocephin for cellulitis. We are a non-facility provider, using POS 20 for all UC services. Lately we've been getting denials from insurance companies stating that the service does not meet Medicare guidelines. I searched CMS website and found information about chemotherapy IVs, but nothing that fits the kind of treatment we are doing. Any input about this subject would be greatly appreciated.

 

[maysons1703]

Have you searched the LCD edits to see what diagnosis are medically necessary for the procedure code you are using?