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Wiki Pessary Supply Billing

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melheffley

Networker
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Location
Caledonia, OH
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Does anyone know how Humana Medicare wants the Pessary (A4562) billed? We have always billed place of service 11, but recently are getting denials as invalid place of service. I asked the Humana representative where to find the policy and her only answer was "we follow Medicare's guidelines for the billing and place of service requirements". We have never had this problem before with any plan, including Medicare. We have been denied for 2 different patients. Both patients live at home and are NOT in a nursing home or assisted living.
 
I never did get a response on here. We tried changing POS to 12 and it actually paid without problems. That appears to be the answer. Now however, we are having problems with "exceeds the contracted maximum by this provider for this time period". I'm not sure what the policy is on that.
 
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