pellet implants/insertion 11980

[ewinchel@drprevent.com]

11980 was always used for male and female hormone pellet insertion.
My female patients are now denying, saying new code.
Can someone please help me with new code for females?
I have looked in the CPT book and cannot find it or reference to revised code.
I really am grateful for your time.

 

[azharshaik]

Pellet implantation

Hi,
See the below info if it is useful..

Applicable service codes: 11980, J3490, S0189
Diagnoses that are subject to medical necessity review: V07, V07.4, 627, 627.1, 627.2, 627.3, 627.4, 627.8, 627.9
ICD-10 diagnosis codes: E89.41, N95.0, N95.1, N95.2, N95.8, N95.9, Z79.890
BCBSNC may request medical records for determination of medical necessity

https://www.bcbsnc.com/assets/servi..._for_hormone_replacement_therapy_in_women.pdf

diagnosis codes, diagnosis coding

 

[kdaugherty1967]

I am having the same problem

The pellet insertion used to be covered by Medicare and now they are denying the code for not medically necessary.

Please help if anyone has the information for this.

Thanks

diagnosis codes, diagnosis coding

 

[CodingKing]

The pellet insertion used to be covered by Medicare and now they are denying the code for not medically necessary.

Please help if anyone has the information for this.

Thanks

One of my LCD's states not FDA approved:

[h=1]Implantable Hormone Pellets (L35658)[/h]

While implantable estradiol pellets have been suggested as treatment for symptoms of menopause, there are no Food and Drug Administration (FDA)-approved, commercially available formulations of implantable estradiol pellets available in the United States. These formulations of estradiol have been shown to produce unpredictable serum concentrations of estrogen. The FDA's Fertility and Maternal Health Drugs Advisory Committee unanimously agreed to terminate compassionate investigative new drug (IND) programs for estrogen pellets as a last-resort treatment of menopausal disorder.

diagnosis codes, diagnosis coding

 

[Samfoster]

Any new info?

Are your claims for female treatment still being denied or were you able to resolve this issue?

diagnosis codes, diagnosis coding