Question Medicare denials for 20610

klamond

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Is anyone else (all of a sudden) receiving denials for CPT code 20610 for medical necessity/ based on a LCD? I have searched high and low for the LCD to no avail. I have called our contractor for guidance and I'm told to search online, which I have. I can only find LCD for Hyaluronan Acid therapies but these injections do not pertain to that. I know its usually a dx issue but I cant find the guidelines. Any info or advice would be greatly appreciated.
 

klamond

Networker
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32
Location
Hamilton
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I called Novitas Solutions (Medicare) again today. I had the rep stumped. She referred me again to LCD L35427 and Article A55036. I advised these are NOT Hyaluronan injections. I even have a couple denials for shoulder injections that the remit advice is referring me to the knee LCD. She stated she has been getting calls all day re denials for same reason. She said when they did the revision to the LCD recently it must have created a flag for denial on 20610 and that we should send in redetermination with documentation for now until it is corrected on their end. So here goes all the extra work on our part. :(
 
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