Good afternoon. I am assisting with the billing for ESRD (monthly) dialysis in the state of Pennsylvania. We are hitting a road-block with billing the 90962-90962 codes with two particular PA Medicaid HMO insurances. Both are denying the charges because the CPT codes are not on the Pennsylvania Medicaid fee schedule.

This is very frustrating because the insurances will not help us at all. How can monthly dialysis charges be billed if the codes that should be used are not on the fee schedule?

Does anyone have any suggestions? We have thought of maybe billing E/M codes for the service, however, are unsure if an E/M code would be paid in the place of service 65.

Any help, suggestions, links, anything is always greatly appreciated!

Thank you