Wiki Levulan sticks to medicare

[LACEY13]

Good Morning,

We got a denial from Medicare for billing in units four levulan sticks. Can anyone please let me know what the medicare guidlines on codign for this are and what there usual limits are, and maybe even the link to where is says this on the medicare website. That would be great!!!! THANKS

 

[peachygirl]

Hello,
The units shouldn't be a problem, it just depends on the reasoning for using that many sticks. Did the Dr do several locations in one visit? We've been paid for using up to 2 J7308 units to Medicare, as long as the dx is 702.0 and it is billed with the appropriate 96567, you should be fine - did they give you a denial code?
You can access all LCD's for medicare at http://www.cms.hhs.gov/mcd/ (just search for LCD ID# L28232) and this will bring up the dx/CPT codes covered for actinic keratoses. (You can also use this site to find coverage determinations for all Medicare codes)

Hope this helps!
Mallory E, CPC