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0192T denial

  1. Question 0192T denial
    Medical Coding Books
    Has anyone had 0192T denied from Medicaid. they are saying it is a non covered code.

  2. Cool 0192t
    No we have not received a denial from Medicaid but have heard from our supplier that 0192T will no longer be reimbursed by Medicare. Has anyne else heard anything regarding Medicare not reimbursIng?

  3. #3
    Default Coverage for 0192T
    The recent change in coverage for 0192T is applicable only to Novitas (formerly Highmark). Novitas is the Medicare Administrative Contractor (MAC) for Jurisdiction 12 (J12) that includes Delaware, New Jersey, Pennsylvania, Maryland, and the District of Columbia. For Part B services, the A/B MAC J12 includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia. Effective April 14, Novitas changed their policy (L31686) and deemed ALL Category III CPT® Codes not medically necessary, even though Highmark previously provided coverage for 0192T.

    Industry leaders and the medical community are appealing to Novitas to reverse this policy. All other Medicare programs continue to provide coverage for 0192T.

    0192T is covered by Medicaid programs in AZ, AR, CO, MI, MT, SC, and WV. However, as is typical with State Medicaid programs, some do not cover emerging technologies or they provide coverage on a case-by-case basis.

    Best regards,
    Valerie Ditterline, CPC

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