Medicare-frequency of injections-LCD question

[gnhobbs@ppmh.org]

Confusion of the LCD L32112 and L32116

we have claims denying for patients who have bilateral injections/facets/MBBs/RF's because for each side they have to have the same # of injections and that puts them over the limit on the # of injections they can have per year. We have them sign an ABN, but still, is there anyway to fight/clarify this because the LCD's state "per region".

Also, L32112 states "injection sessions per region"
and L32116 states " facet injection sessions"

so, does that mean they can have 6 regular injections AND 6 facet/rf injections?

of course, can't get any clarification from Medicare reps..

thanks in advance for any advice/help

 

[jleonefl]

LCD clarification

Contact medical.policy@fcso.com for clarification of their Medicare FFS policy in FL. If you need something changed you can ask for a reconsideration to the policy. There's a formalized process to request a change which is cited on their website at www.fcso.com. Hope this helps.