EMK
Contributor
We are getting denials the last several months on our diagnostic PSA's (84153) when we bill for patients over age 70 with a valid DX from Wellcare. They are stating that per the CMS Internet Only Manuals NCD policy says you can not bill over age 70. They referenced me to decision point 598.0 policy reason CPTAG. The rep read it to me over the phone but cannot direct me to it in print and I have scoured CMS's website and cannot find anywhere where it says age 70 or over is not payable. Anyone else having this issue or can you direct me to where they are seeing this in print????? 