Wiki 64640 getting Denied by BCBS!

[Mehboobfidai5@gmail.com]

Hi,

I am in the Midwest BCBS market and they consider 64640 as investigational but MC, Coventry and Cigna reimburse. Using it for Cervicogenic HA and RFA of TON; should we bill as 64999? What are the chances that we get reimbursed by the insurance company (BCBSKC). It is frustrating? Any coding solutions? What is the experience with 64999 reimbursement process ?

 

[CodingKing]

You cannot use an unlisted code if there is another appropriate code available. You may need to appeal.

I cant find the Midwest policy but found the following from North Carolina.

https://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/facet_joint_denervation.pdf

When Facet Joint Denervation is covered

Non-pulsed radiofrequency denervation of cervical facet joints (C3-4 and below) and lumbarfacet joints may be considered medically necessary when the criteria in the Policy Guidelinessection below are met.

When Facet Joint Denervation is not covered:

Radiofrequency denervation is considered investigational for the treatment of chronic spinal/backpain for all uses that do not meet the criteria listed in the Policy Guidelines section, including butnot limited to treatment of thoracic facet or sacroiliac (SI) joint pain.

All other techniques of facet joint denervation for the treatment of chronic back pain areconsidered investigational including, but not limited to:

• Pulsed radiofrequency denervation;
• Laser;
• Cryodenervation;
• Chemical denervation (e.g., alcohol, phenol, or high-concentration local anesthetics).

Therapeutic (as opposed to diagnostic) medial branch blocks are considered investigational.