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Wiki BlueCrossBlueShield of TX Appeals Speech Services

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keepsweep18

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I am having trouble with BC/BS of Tx. I have appealed speech therapy services. Procedure Codes: 92506 & 97507 ICD 10: F80.0 (phonological disorder) Services rendered by a licensed SLP. We are located in Idaho and billed the local BC/BS. Services are processing towards the "mental Health" benefits. This is almost double patients speech therapy benefits. We received a denied appeal and it states we have exhausted our internal appeal rights. They denied on the pretense that F80.0 is listed in the CPT chapter 5 manual specific to mental, behavioral, and neuro disorders. This diagnosis is one of the top 25 diagnoses codes used/billed by SLPs. Why would they still be denying services and how can I get them to recognize computers are not perfect and this is billed accurately. They advised us to rebill with a different diagnosis and having a push back from the therapist saying it is accurate. We will appeal towards an independent review organization 3rd party and wanted to see what advise anyone may have problems they have seen with this with other carriers etc.

Thank you,

Jim Burnett, cpc
 
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