# Medical Necessity for CPT 33249 - We have received a few denials



## cherrera26

Hi
We have received a few denials from Medicare of Florida for Procedure 33249 , I have tried to look in CMS to get the Rules and ICD-9 odes that we can use to support the Medical Necessity in several occasions without any success.
Does anybody here has the guide lines or any LCD from CMS with this information.
Please advice.
thanks.


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## cweavercpc

*Getting paid for AICD's (33249)*

Are you billing the code with the Q0 or Q1 modifier? I refered to NCD 20.4 and several MLN Matters Articles:

MM4273  Transmittal# R819CP
MM5805  Transmittal# R1418CP
MM3604  Transmittal# R497CP
MLN Matters Number SE0517

All of this if very useful information and we have been getting paid. I have all of this information scanned and can gladly email anyone who needs it to save you time. Just give me your email address or send me a personal message. Hope this information helps and let me know if you have any questions.


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## cherrera26

no, and I think that is one of the reason we are not getting paid, but I want to be sure that we can use it for Medicare of Florida.
I sent you an email with my Email address and I will really apreciate if you can send me thise documents.
thanks.


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## cweavercpc

*cherrra26*

I just emailed you the documents. Please let me know if you did not recieve them. Hope they help!


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## Bphelps

I would really appreciate any help on the 33249, Florida Medicare Part B keeps denying.  Recently, claims were sent with the QO modifier and medicare denied those claims for the QO  modifier.


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## cmsaral

*Q0 Modifier with LCD to go  with it*

It not QO that you use its Q0 = Q, (0) :zero not Q, O. it also needs a Diagnosis that Medicare approves.


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## ruthwalker

cweavercpc said:


> Are you billing the code with the Q0 or Q1 modifier? I refered to NCD 20.4 and several MLN Matters Articles:
> 
> MM4273  Transmittal# R819CP
> MM5805  Transmittal# R1418CP
> MM3604  Transmittal# R497CP
> MLN Matters Number SE0517
> 
> All of this if very useful information and we have been getting paid. I have all of this information scanned and can gladly email anyone who needs it to save you time. Just give me your email address or send me a personal message. Hope this information helps and let me know if you have any questions.


Hi C. Weaver,
We would truely appreciate any information you have on the AICD and medical neccessity DX...we have just started to get a couple of denials and any information you have would be great...my e-mail is rwalker@ccvmg.com...thanks for your help...


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## mandiehead

*Denials for CPT 33249*

Can CPT 33249 only be billed with the Q0 and Q1 modifiers?  We perform this procedure, but not for clinical research, therefore those mods seem inappropriate.  However, we are receiving many denials from Medicare of Louisiana.  Can you please advise?  Thanks.


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## sueolson

I would love the info emailed to sue.olson@wth.org


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## twizzle

*33249q0*

To use the Q0 modifier the patient must be Medicare with the dx codes for congestive heart failure and/or cardiomyopathy (non ischemic) 425.4. Also if they have v tach and/or a history of sudden cardiac death V12.53 you would NOT use Q0.
By using Q0 they are showing that the patient has the potential for sudden cardiac death hence the 33249 is being done for primary prevention. Use the Q0 for 33240 for the same reasons when the patients' ICD is at elective replacement time.
Hope this helps.


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## marty3073

*Hi*



cweavercpc said:


> Are you billing the code with the Q0 or Q1 modifier? I refered to NCD 20.4 and several MLN Matters Articles:
> 
> MM4273  Transmittal# R819CP
> MM5805  Transmittal# R1418CP
> MM3604  Transmittal# R497CP
> MLN Matters Number SE0517
> 
> All of this if very useful information and we have been getting paid. I have all of this information scanned and can gladly email anyone who needs it to save you time. Just give me your email address or send me a personal message. Hope this information helps and let me know if you have any questions.



Could you send me the information also. My email address: marty3073@yahoo.com

Thanks


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## sallystavola

*33249*

When using the Q0 modifier do we need to be registered with the national registry.  We are getting several denials but I want to make sure we are using the modifier correct. Thank you.  Sally


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## dnm4345

*Reply*

I would like that info to if you don't mind...dnm4345@hotmail.com THANKS!!!


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## Lisa Bledsoe

sallystavola said:


> When using the Q0 modifier do we need to be registered with the national registry.  We are getting several denials but I want to make sure we are using the modifier correct. Thank you.  Sally



I believe that the facility that actually incurs the cost of the device registers the #'s identifying the device.  On your claim, I believe you also need to enter the serial # of the device in addition to the Q0 modifier and the appropriate dx codes.


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## stephanieOC

Hi,

Do you still have the information regarding the Q0 modifier? if yes, could you please email to me at stephanieo7580@gmail.com

Thank you
Stephanie


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## CherylMac2

*33249*

For this same issue ours is stating you must also report the applicable Device with 33249...do you know which device code they are referring too? 





cherrera26 said:


> Hi
> We have received a few denials from Medicare of Florida for Procedure 33249 , I have tried to look in CMS to get the Rules and ICD-9 odes that we can use to support the Medical Necessity in several occasions without any success.
> Does anybody here has the guide lines or any LCD from CMS with this information.
> Please advice.
> thanks.


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