Lesion Excision and Medicare/California


Best answers
Since our area switched to Palmetto Medicare, we have had a problem getting any sebaceous cyst or lipoma excisions paid for by Medicare. We understand that we are to have the patient fill out an ABN form, but Medicare won't pay for any of them even if we use a secondary code that indicates that the patient had an infection/cellulitis/pain etc. We would appeal them and once and awhile they will pay, but usually they will deny them even with supporting documentation showing what would seem to be medical necessity.

We did not have this problem before our area changed Medicare carriers. It is really difficult for a patients to make a decision because we can never tell them what the outcome will be for sure, and often the doctor is not sure if they have a cancer prior to the excision, so the patient either does nothing and faces a major problem later, or they could end up paying doctor's and facilities fees if it is done in a surgery center outside of our office.

Does anyone have any suggestions? Is everyone getting these denied, and if not how are you getting paid by Medicare?