United Healthcare/RFA's

christine_cornforth

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Has anyone had any success getting the RFA's paid for by United Healthcare? We have a handful of patients that my doctor has done the RFA's on (CPT 64635 & 64636). United Healthcare keeps denying them as experimental.....can anyone help??
 

christine_cornforth

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We are billing according to the UHC coverage guidelines and they are still denying as experimental. I am in the process of looking at our individual contract to see if there are roadblocks there.
 

KMCFADYEN

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Has the doctor performed a Medical Branch Block with 50% or more relief prior to the RFA?
If the answer to this question is no, then that will get you a not medically necessary denial from United Healthcare
And has the patient had previous RFA less than six months prior?
If the answer to this question is yes, then that will get you a not medically necessary denial from United Healthcare.
 
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