Wow that is shocking to me. At our office we use a book called the CSI Navigator and there is a section that states "most payors consider an infant to be less than one year of age", so that is what we go by when using the infant xray codes. I work denials in our office and had one returned that an infant upper extremity code was used on an 18 month old and they denied for age appropriate CPT, so we refiled with the forearm and humerus codes and it got paid. But I have never heard of the AMA having that rule on xrays and I can't find it anywhere in the CPT book or online. As far as I know we only have those few age specific "infant" ones and those are for the babies. I always use the rest for age 1 year 1 day and older and have never had a problem.
Good Luck, it seems like Wellcare is just being subborn.
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