Wiki Radiation Therapy: 77014 Medicare Denial

[Csimens]

In May 2020, Medicare began denying the conebeam 77014 when billed within 14 days of 77301. We sent documentation to Medicare and stated that the denial was an error and fixed the problem reprocessing the claims for payment.
Now Humana Medicare, and BCBS are denying the same way but will not overturn the denial even after sending in the ASTRO letter that was sent to Humana.
BCBS is stating that they are following Medicare guidance. I have not been able to find any update from Medicare that would have gone out to commercial payors to begin this denial.
Has anyone else has this same issue?

 

[jflynn124]

I've only had this problem with Humana. I wrote a very strongly worded letter of appeal breaking down what Medicares policy actual states which is; 77014 cannot be billed within 14 days of code 77301 if the 77014 is being used for the planning. I explained to them that once the planning is complete, then and only then do we start billing the 77014 for radiation guidance. I should receive a response within the next 2-3 weeks.

 

[Csimens]

I've only had this problem with Humana. I wrote a very strongly worded letter of appeal breaking down what Medicares policy actual states which is; 77014 cannot be billed within 14 days of code 77301 if the 77014 is being used for the planning. I explained to them that once the planning is complete, then and only then do we start billing the 77014 for radiation guidance. I should receive a response within the next 2-3 weeks.

We now have an issue with BCBS denying 77014. Have you seen this? Humana did change the edit according the ASTRO website and will be resprocessing the 77014 denials within 14 days of 77301, but so far BCBS is upholding their stance. Has anyone else has success with BCBS?