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Humana denying SCS Adjustments

  1. #1
    Default Humana denying SCS Adjustments
    Medical Coding Books
    I need some help. Our physicians are implanting permanent spinal cord stimulators, and when the pt's come back in for reprogramming/ adjustments (CPT: 95972)- Humana is denying stating not related to diagnosis submitted. Usually, some of the denials I've received are for DX: 724.4-lumbar radiculitis/neuritis. Any ideas? I can not find anything specific on the medical policy as to if there's only specific dx that they allow with this cpt.

  2. #2
    Did the physician document that he actively participate while the rep perform the programming?

  3. #3
    I have seen that denial code from Humana before and questioned the account rep if they have a set of medical policies with what Dx's they considered meet medical necesscity for the procedure. But I think they don't this is just delay tatic so they don't have to pay any claims. I agree that usually the code that is used for the programming is same or similiar to the reason the device was implanted. The only other code you could look at is

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