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L1833 billing on same date as outpatient surgery

  1. Default L1833 billing on same date as outpatient surgery
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    One of the surgeons I bill for dispenses L1833 knee braces to some of his outpatient surgery patients. United Healthcare commercial plan used to pay for these braces, but around April 2018, it stopped paying and started denying the braces as part of the global service. I called and spoke to a rep about a policy change. She denied any knowledge of a change in policy and suggested I do a reconsideration. UHC denied the reconsideration stating the claim was paid correctly. Does anyone have any advice they can share? Thank you.

  2. #2
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    what was the reason for denial on the eob? We use modifier KX on the code and we have not had an issue getting paid.

  3. Default
    The denial reads that these services are not covered when performed within the global period of another service. We only use the medically necessary KX modifier on Medicare claims and some Medicare replacement plans. Do you use the KX on commercial plans?

  4. #4
    Default
    United follows CMS guidelines so we use the KX for them. I checked allowed modifiers to see if 58 was listed but its not. I also searched the united medical policies and I couldn't find one referencing anything about dmes being included in global. Are you using place of service 12?

  5. Default
    Medical Billing
    Yes, we use place of service 12

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