Question Physican billing for Car Seat codes 94780

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Are any insurances reimbursing physicians for these Car Seat testing codes? 94780-94781.
My Pediatric Hospitalists want to charge and Revenue Dept states they will deny.
They are listed on the AAP coding for Newborn decision Tool for 2021 and listed under Medicine/Allergy/Clinical Imm in the CPT Prof edition
book.

Thank you for any experiences good or bad you have had with billing.
 
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138
Best answers
0
Are any insurances reimbursing physicians for these Car Seat testing codes? 94780-94781.
My Pediatric Hospitalists want to charge and Revenue Dept states they will deny.
They are listed on the AAP coding for Newborn decision Tool for 2021 and listed under Medicine/Allergy/Clinical Imm in the CPT Prof edition
book.

Thank you for any experiences good or bad you have had with billing.
I have been trying to get these codes paid for years and have not been successful. The only time I have been able to get them paid is by Medicaid and only if the baby was premature or had problems during the course of the admission.
 
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R Thomas -some old thread posts that came up in forums, state that the Physician needs to write a separate note and then appeal. Do your Drs do that? and still get denied except for Medicaid? We only do the test if the baby was premature or had breathing issues. The book states needs obsv and continuous recording with heart rate and resp. The Dr. is writing that in the note.
Just curious, what denial code are insurance using? It is listed on the 2021 Am Academy of Pediatrics under critical care codes along with 31500, 62270, etc. Thank you
 
Messages
138
Best answers
0
R Thomas -some old thread posts that came up in forums, state that the Physician needs to write a separate note and then appeal. Do your Drs do that? and still get denied except for Medicaid? We only do the test if the baby was premature or had breathing issues. The book states needs obsv and continuous recording with heart rate and resp. The Dr. is writing that in the note.
Just curious, what denial code are insurance using? It is listed on the 2021 Am Academy of Pediatrics under critical care codes along with 31500, 62270, etc. Thank you
We have never tried getting the Drs to write an appeal themselves. A few denials we have gotten are N216: We do not offer coverage for this type of service, N130 Consult plan benefit documents/guidelines doe information about restrictions for this service.
The insurance that we have had success in getting reimbursement from is our State Employee BCBS plan.
 
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