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Wiki TAVR/Clinical Trial procedures Medicare only?

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nclb85

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Hello! We have a TAVR claim that has been denied by Humana multiple times now. Our AR team called Humana and were told that straight Medicare should be billed because advantage plans do not pay for clinical trial procedures (we have multiple other claims with the same procedure, and others, paid by this same Humana plan - Gold Plus HMO). They also called to verify with Medicare and the rep agreed that it has always been policy that Medicare should be billed when a patient has an advantage plan. Is this really the case? We have been doing these procedures for many years now and I've never seen that expressed in any coding/billing directions, I'm also not able to find any policies that agree.

Anyone else experiencing this? Thank you!
 
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