moodyk13
Contributor
I work for an ambulance provider and when ICD-10 hit, Amerigroup started denying pretty much every mental health code as "medically unnecessary" that is classified as emergency. Apparently there are LCD's for my region (Georgia) that they use (though no other problems with other Mcaid carriers.....) Anyway, I have searched and searched and searched - for months now and have made little progress.
I can find a list of LCD's for all the contractors except Cahaba GBA - who of course is our contractor - seem to have a list of LCD's on the CMS website. Our LCD is L34302 but the only thing that comes up is "XX000" which makes me think we have no LCD limitations - but then Amerigroup keeps denying.
So THEN I think maybe NCCI applies in a different way as to the order they want the codes in, or families, or whatever, but looking at the codes and combos of codes they deny, I cannot identify a common pattern or anything that helps me figure them out.
Any feedback, answers, suggestions would be great!
P.s. I called Cahaba GBA and got NO help - when I asked for someone to call me back I was told "sure if you want to wait 7 - 10 days". I called Amerigroup and they said they could not provide LCD's to anyone - up to us to "figure it out"-------
I can find a list of LCD's for all the contractors except Cahaba GBA - who of course is our contractor - seem to have a list of LCD's on the CMS website. Our LCD is L34302 but the only thing that comes up is "XX000" which makes me think we have no LCD limitations - but then Amerigroup keeps denying.
So THEN I think maybe NCCI applies in a different way as to the order they want the codes in, or families, or whatever, but looking at the codes and combos of codes they deny, I cannot identify a common pattern or anything that helps me figure them out.
Any feedback, answers, suggestions would be great!
P.s. I called Cahaba GBA and got NO help - when I asked for someone to call me back I was told "sure if you want to wait 7 - 10 days". I called Amerigroup and they said they could not provide LCD's to anyone - up to us to "figure it out"-------