Wiki 0192t help!!!!

[ohiocoder101]

Hello all,
I work for an ASC and have come across that cgs medicare is not paying the
0192T stating not medically necessary, due to an LCD. I bill with dx 365.11. I have found info on the cms website info on this, listing the LCD's. Is anyone else having this issue? if so, how and what are you doing to recieve payment from medicare?

Thanks to all in advance!

 

[vditterline]

CGS Local Coverage Article for 0192T

The CGS Local Coverage Article A50755 states “An anterior segment aqueous drainage device, without extraocular reservoir, implanted under a partial thickness scleral flap may be a safe alternative or adjunct to standard guarded trabeculectomy, especially for patients with advanced glaucoma in need of low intraocular pressures with a high risk for hypotonous complication” and lists “ICD-9 Codes that are Covered” as 365.10-365.15.

If you have received a denial for 0192T that meets these criteria, you should consider appealing the claim. If you need assistance with your appeal, the manufacturer of the device may have resources available to you.

The CGS Local Coverage Article is available at http://www.cms.gov/medicare-coverag...2&CptHcpcsCode=0192t&kq=true&bc=IAAAABAAAAAA&

Best regards,
Valerie Ditterline, CPC
Alcon Reimbursement Services
Valerie.ditterline@alconlabs.com
866.457.0277
http://ars.alcon.com