Wiki 97542 reported by PT & OT

[bdurham67@gmail.com]

Hello,

We have been getting denials from MassHealth whenever our Physical and Occupational Therapists report 97542 for Wheelchair management. It's a bit frustrating as our patient population is mainly physical, mentally and neurologically disabled and this is part of their plan of care. MassHealth only stated that the code is a for medical procedure and our Rehab folks' specialty does not state they are acceptable to use that code. MH would not pay if this is the patient's primary insurance but will pay if it is secondary.

Can anyone assist with this please? Does anyone know what might be the reason for them not being able to use that code and what might be a solution?

Many thanks for your help with this.

 

[bdurham67@gmail.com]

Hello,

We have been getting denials from Medicaid whenever our Physical and Occupational Therapists report 97542 for Wheelchair management. It's a bit frustrating as our patient population is mainly physical, mentally and neurologically disabled and this is part of their plan of care. Medicaid only stated that the code is a for medical procedure and our Rehab folks' specialty does not state they are acceptable to use that code. MH would not pay if this is the patient's primary insurance but will pay if it is secondary.

Can anyone assist with this please? Does anyone know what might be the reason for them not being able to use that code and what might be a solution?

Many thanks for your help with this.

I meant Medicaid, I am in Massachusetts so I am referring it as MassHealth (Medicaid)