Heatherc7
Guest
Hello,
As of 1/1/2023, Providence Med Advantage plans have a new foot care policy (see attached.) All of our CPT 11055-11057 are being denied as not covered patient responsibility. I called the health plan and was told that can't be billed with L84 as the primary Dx. The secondary Dx is E11.40. They state they're following Medicare guidelines see: https://www.cms.gov/medicare-covera...e.aspx?articleid=57957&ver=40&bc=CAAAAAAAAAAA. After reviewing the LCD for Routine FC, it appears we are meeting Medicare guidelines.
Now, I'm being told to appeal. I believe this is a lot of effort to go through, especially since we are following Medicare guidelines.
Any helpful advise, would be welcome.
As of 1/1/2023, Providence Med Advantage plans have a new foot care policy (see attached.) All of our CPT 11055-11057 are being denied as not covered patient responsibility. I called the health plan and was told that can't be billed with L84 as the primary Dx. The secondary Dx is E11.40. They state they're following Medicare guidelines see: https://www.cms.gov/medicare-covera...e.aspx?articleid=57957&ver=40&bc=CAAAAAAAAAAA. After reviewing the LCD for Routine FC, it appears we are meeting Medicare guidelines.
Now, I'm being told to appeal. I believe this is a lot of effort to go through, especially since we are following Medicare guidelines.
Any helpful advise, would be welcome.