tci Medicare Compliance & Reimbursement - 2013 Issue 5

Reader Question: Report Payers That Don't Accept New Codes

Question: We already have payers that are rejecting the new CPT® codes. They are not stating that the codes aren’t valid for the procedure we are performing, but rather stating the codes are not valid at all. How should we handle this? Answer:  You should first appeal the claim. If you are correctly using a valid, new CPT® code that went into effect on Jan. 1, 2013, you should appeal the claim. Be sure that you are using a valid code for the proper procedure and that you have checked your payer’s local coverage determination (LCDs)...

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