Wiki pain management

[ranna1]

I am getting denial from Medicare when i bill 64450 with diagnosis 355.3. i checked the LCD coverage and up to my understanding it is a covered diagnosis for this procedure. can some one please tell me if there is any thing wrong or I am miss some thing. thanks

 

[dclark7]

Who is your medicare MAC? Unless there's a National Coverage Determination put out by CMS each MAC may eastablish their own LCD, so this would make a difference.

 

[ranna1]

our Medicare is Cahaba GBA. that is in ALABAMA

 

[KMCFADYEN]

I believe there is a local LCD for that procedure. Is your denial for not medcally necessary?

 

[ranna1]

pain managment

yes the denial reason was 'not medically necessary"