# Prostate biopsy/Transrectal Ultrasound denial



## almag69 (Oct 2, 2015)

Our office bills for Prostate biopsies and we use codes 55700, 76872 and 76942. 

In the last month I have had UHC and Aetna deny our 76872 code, is anyone else experiencing this?

I looked up the policy criteria and there are certain criteria to be met but we have been billing this way for years and never received a denial indicating not medically necessary.

Any information would be appreciated, thank you.


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## TammyHF (Oct 12, 2015)

We are also getting those denials too.

We were told that the transrectal ultrasound is against Aetna policy but we could try appeal it showing it is a integral part of the prostate biopsy by documentation they may reconsider it. I don't know how that how that appeal process is going but I know we have had that issue since May or June.

As for UHC we have been able to appeal the TRUS biopsies after 7 but a couple of weeks ago we got a denial of a TRUS biopsy appeal stating we are not following their policy. We have asked for their policy showing the limited why they only allow 7 prostate biopsy samples. 

If anyone is having any luck getting these paid PLEASE let me know. 

Thank you!!!!


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## jflynn124 (Nov 1, 2015)

We have no problem getting these paid, we take 12 samples and bill 6 on one line and the other 6 on another line w/mod 59. UHC told us last year this is how they want them billed and we've had no problems ever since.


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