Louisiana Medicare denial 20610

alumnieib

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CPT 20610 is listed under the LA MCARE LCD for Hylan Polymers and there are only a few diagnosis codes that are covered.

However, I have several that are denying that are using kenalog as the injection drug and these are all denying CO 50 also. There is no other LCD, Doc is not using a Hylan Polymer. Has anyone run into this before and how should I remedy this? Send records in all the time?
 

btadlock1

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CPT 20610 is listed under the LA MCARE LCD for Hylan Polymers and there are only a few diagnosis codes that are covered.

However, I have several that are denying that are using kenalog as the injection drug and these are all denying CO 50 also. There is no other LCD, Doc is not using a Hylan Polymer. Has anyone run into this before and how should I remedy this? Send records in all the time?
CO50 is non-covered for medical necessity - Since there's not a specific LCD (aside from the Hylan Polymer), you might have to defer to NCD's - Call and ask them what about the claim is causing the denial (eg, type of drug, diagnosis, frequency, etc.)

What Dx are you using? Is it an 'unspecified' or 'NOS' code? If it's specific, and can be tied to the need to do an injection, you might try appealing with records.
 
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