Wiki Medicare Recent Denial For CPT 15273

[kerinnejb@icloud.com]

Skin Substitute Grafts: CPT 15273 …first 100 sq cm wound surface area, or 1% of body area of infants and children. For years we’ve billed this code to Medicare for application of homo/allo/xenografts to adults And received payments (Eg 150 sq cm of homograft applied to a 67 year old: The 1st 100 sq cm is billed with 15273 and the remaining 50 sq cm is billed with CPT 15274). Recently Medicare has been denying payments for CPT 15273; per Medicare this CPT is used to bill only grafts performed on infants and children and no option to appeal. Has anyone experienced this issue and if so have you found a solution to billing …? Thanks

 

[thomas7331]

In my opinion, this is clearly an error on the part of your Medicare contractor - they have misread the language in the code description. I imagine the reason you're getting the 'no appeal allowed' is because it's being denied as invalid billing, which means it's something they've programmed into their system to reject up front. I don't know of any way of getting around this other than to wait for them to correct the error, which they will have to do at some point. I would recommend making a phone inquiry and requesting that it be escalated to a higher level specialist who can research the problem and make sure they're looking into it.