Wiki 92250 Rejected By Medicare

[ponyboytfj]

Hello,

I recently started billing Medicare. Every time I bill 92250 it gets rejected (occasionally with other procedure codes). The denial reason is that it is missing information. I have searched for hours on the internet, among looking through my AAPC books, and can't find what to do. Am I supposed to be including some other information? We had a previous biller and from the information I can see, I am filing my claims the exact same way he did, and his claims were always approved.

Thanks to anyone that can help,
Damien

 

[sls314]

Hello,

I recently started billing Medicare. Every time I bill 92250 it gets rejected (occasionally with other procedure codes). The denial reason is that it is missing information. I have searched for hours on the internet, among looking through my AAPC books, and can't find what to do. Am I supposed to be including some other information? We had a previous biller and from the information I can see, I am filing my claims the exact same way he did, and his claims were always approved.

Thanks to anyone that can help,
Damien

What diagnosis code are you using? Is that diagnosis listed as covered on the Medicare LCD?

I'm assuming you are in New York - here's a link to the LCD that should be applicable: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56726