Wiki Medicare non covered diagnosis

[herrera4]

we have a patient whose surgery was denied as noncovered diagnosis for medicare-patient does have Medicaid secondary-is that billable to billable to Medicaid?

 

[awarnke]

Medicare Non covered dx

You need to go to the cms website and go over the LCD list ..Medi-cal will not pick anything up unless medicare pays first .....

 

[cghanbari]

I am curious what was the surgery that was denied payment? We never have to get a prior authorization for surgery in Tx. And never been denied for payment for any surgery I've billed

 

[herrera4]

it was gastric bypass-but by the time the surgery happened-bmi was just under-that's why it was denied for noncovered diagnosis-we don't need to get the preauth for surgeries

ill double check the LCDs again
Thanks