Wiki 69100 medicare denial

[O_KRECHKIVSKA]

Recently we got a lot of unpaid Medicare claims with CPT 69100. This code was billed to Medicare alone and some claims had office visits (with Mod-25) and Biopsy of external ear (69100). We received them with CARC CO-16 and RARC MA130, N822. I created Electronic Inquiry with NGS, received email from them that it is being worked and they will notify us by email when a response is available.
Does anybody else have this situation and what should I do? We didn't have this in past, it started as of last year (2024). It is a medical necessity to do this procedure and we don't code a general biopsy (11102, etc) instead of ear biopsy code (69100).

 

[reaganm222]

I'm having the same issue with Medicare and Medicare replacements. Have you received a response back about your inquiry?

 

[O_KRECHKIVSKA]

Hi, medicare still denies CPT 69100, but Aetna medicare advantage paid this code. I opened enquiry with NGS but I have no respond from Medicare till now. Usage of Mod-59 along with CPT11101 doesn't help, we tried to bill the code along and with Office visit - denied by medicare

 

[MBLAIRE]

Recently we got a lot of unpaid Medicare claims with CPT 69100. This code was billed to Medicare alone and some claims had office visits (with Mod-25) and Biopsy of external ear (69100). We received them with CARC CO-16 and RARC MA130, N822. I created Electronic Inquiry with NGS, received email from them that it is being worked and they will notify us by email when a response is available.
Does anybody else have this situation and what should I do? We didn't have this in past, it started as of last year (2024). It is a medical necessity to do this procedure and we don't code a general biopsy (11102, etc) instead of ear biopsy code (69100).

Working on a denial for 69100 from Medicare right now. Glad to see that it isn't isolated to just my clinic.