Wiki Anthem of VA denying CPT 64561 with mod 50 performed in the ambulatory surgery clinic

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csrigney26@outlook

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Anthem of VA has been denying CPT 64561 with modifier 50 and CPT A4290 (we were told by Anthem to change code to C1897). We have resubmitted the claim per Anthem's instructions but they are still denying this claim. The denial reasons are service included in the allowance for another service (Patient has not had another procedure), device-dependent procedure reported without device code, service does not qualify for payment under the outpatient facility fee schedule. The physician was paid for his services to perform the procedure. Anthem is the only payer that we are having issues paying for this CPT code. Just wanted to see if anyone has had this same issue with Anthem and how they resolved it.
Thanks for any help or advice.
 
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