Wiki Video Swallow - Professional Component

[ecampos95]

I have a denial from Aetna for CPT 74230 and modifier 26. I called and the rep stated they are denying our bill because the professional component was performed by a MD vs. a radiologist. Medicare pays for this and so do other insurance companies. The place of service is 21.
Has anyone had experience with this? Has Aetna paid anyone?
I am may try to appeal and am looking for info to back me up.
Thanks!!

 

[MarcusM]

Did your M.D. do a full description of the study like a radiologist would? That's what the carriers will look for, and probably denied the interpretation as included or documentation does not support a separate procedure code.