Routine Foot care / Medicare advantage plans

[NorthernIllinois]

We continue to receive denials for RFC from Aetna and humana medicare plans. we billed code 11720 Q9 with G0127 59 Q9 and we keep getting denied for code G0127 stating its bundled. our diagnosis are based on medicare illinois lcd. Any help would be appreciated

 

[Morgangrace]

Sadly we have the same issue in Nevada/Ca practices however if you are billing Medicare may I suggest changing to modifier XSQ8X2. The 59 modifiers pay at a lower rate but most commercial insurances reject the XS/X2/X4 modifiers . Also, make sure you are using different dx codes when billing both together. Otherwise you may have to bill the 11721 instead. Half the time the G0127 does not get paid by Aetna or Humana even with submitting notes and we end up writing it off so at least we get payment for one rather than both being denied. Hope it helps to know you are not alone in the Nail Debridement struggle.