Wiki Radiology - 76376


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Just to clarify.....LCD from Medicare states that "It is not appropriate to bill Medicare for services that are not covered" and it also states that these codes may be considered medically unnecessary and deny if equivalent information obtained from the test has already been provided by another procedure or could be provided by a standard CT scan without reconstruction. Then it lists a few diagnosis for which the cpt procedures are covered.

The question being asked is if documentation supports billing the 3D but we do not have one of the few diagnosis that they list on the LCD should the 3D code still be billed (with a modifier if appropriate) even though it will deny, or is it not to be billed at all.

I think there is confusion on non covered vs not medically necessary. I would think that if you think documentation supports it then it would be billed but if the diagnosis doesn't support it would deny for not medically necessary....but maybe I'm not reading into this right.

Any thoughts is appreciated.

Sedalia MO