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Wiki Medical necessity for Kyphoplasty

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2
Location
Knoxville, TN
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I code for interventional radiologists and our clearinghouse has started denying Kyphoplasty codes for medical necessity when we bill to Medicare with a compression fracture diagnosis. Example: CPT 22514 with ICD M48.56XA. I reviewed the CMS article A58275 for TN Medicare and am I understanding correctly that on 8/21/22 CMS changed the approved ICD codes to only osteoporosis fracture codes and/or cancer codes? Or have we just been billing incorrectly the whole time? Any additional information on this issue would be greatly appreciated! Thank you!
 
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