Question Medicare Audit on Q4206, Amnio Injections

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We just received audit request from Medicare on the Q4206 from the Southeaster Unified Program Integrity Contractor. The rep stated they are investigating as this may not be a covered service by Medicare? Not Medicare approved? Even though they have been paying on the injections all year. Has anyone else received any audit requests?
 

jewlz0879

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We just received audit request from Medicare on the Q4206 from the Southeaster Unified Program Integrity Contractor. The rep stated they are investigating as this may not be a covered service by Medicare? Not Medicare approved? Even though they have been paying on the injections all year. Has anyone else received any audit requests?
I recently worked for a billing company hired by BioLab (manufacturer) of Fluid Flow Q4206 we were told everything in the article below (from Regenexx) from using specific ICD-10 codes (keeping track of ones that "paid") to "special" prior authorization (Medicare does not provide authorizations), to fluid being replaced. They even went as far to say they had a special person on their team that could get them authorized for us. I typically did pre-determinations and most came back as I&E, not covered on the patient's policy. We received payment on some but for the most part, they were denied. The MACs denied as Investigational & Experimental (I&E), as did private payors. We then learned Medicare was not going to pay for these like the physicians were led to believe. Physicians spent thousands on a product that was not used ethically or within the confines of meeting medical necessity as described in the forum discussion below. To my knowledge, we were never audited. The owner of said billing company caught on and terminated contract as which point I was no longer needed. I'm not sure if Medicare requested money back on paid claims. It was few claims.

We were billing Q4206 for treatment of osteoarthritis with the following CPT codes.

The information shared below by Sharon is enlightening.
CPT CodeDescriptions
20550Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
20551Injection(s); single tendon origin/insertion
20552Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
20553Injection(s); single or multiple trigger point(s), 3 or more muscles
20600Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance
20605Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance
20610Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance


 
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