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Thread: Medical Necessity

  1. #1
    Join Date
    Apr 2007

    Default Medical Necessity

    AAPC: Back to School
    If a patient has a service in the office that is documented medically necessary, but his insurance (not Medicare) will not cover the procedure, can you bill the patient? with or without an ABN? It was a Nerve Conduction Study?

  2. #2
    Join Date
    Apr 2007
    North Carolina


    With a waiver of liablity of file? You should be able to-

    Without a waive on file-This might depend on your carrier. Without a waiver of liability on file, some carriers may make this provider responsibility. It depends on the language within your contract.

    I am curious though...The provider thought it was medically necessary to perform the test yet the carrier denied. What carrier is this? Most have a policy on file for NCS. Are you sure it can't be appealed?

  3. #3
    Join Date
    Apr 2007
    Columbus GA


    Did it possibly need a pre-authorization? Did the patient also have an E&M with these services where it might have needed a 25 mod?

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