Wiki 77300 Benefit Max

[LKaf7]

Hello,

Does anyone have any information about a benefit max for 77300. Payer is Aetna Medicare- we billed 8 units and they denied.

Appreciate any input

Thanks!

 

[sls314]

Hello,

Does anyone have any information about a benefit max for 77300. Payer is Aetna Medicare- we billed 8 units and they denied.

Appreciate any input

Thanks!

Were you billing for the technical or the professional component?

Is it possible that the other provider left off the modifier, so Aetna paid that provider the global rate? Which would make your 8 units appear over the 10 MUE units, even though it really wasn't?

Just brainstorming one possibility. I've had something similar happen with a claim before and it was a pain to get corrected. Thought we did eventually get paid.

 

[rachaelwilleford]

I have found that Aetna does things their own way. What may be fine billing with one payer, Aetna doesn't allow (and no you can't argue that it's allowed by the CPT definition - for example ASTRO has sent out official guidance about imaging and billing 77014/G6002, but Aetna has their own policy and refuses to budge.) These are not usually clinical guidelines but billing guidelines. You would need to specifically ask the payer.

Also how many units were approved for authorization?