Wiki Cpt 99479 and 99480

[thescientist8]

We're getting denials for 99479 and 99480 from (at first) Metro Plus- Denial: Procedure Indicated for Pediatric 1-17 YO - We called them (denial reason is just odd) and they said there was a glitch and they would reprocess the claims.. Then Healthplus and Tricare started denying these codes for the same reason. Anyone got the same issue? This is just bizarre.

PS. our patients were all under 28 days when we billed these codes.

 

[janellglascock@gmail.com]

99480

We are having the same issue with Anthem. They are denying 99480 stating the DX /or Procedure does not agree with the age of the patient. All of our patients are under 28 days. I have checked the weight and dx. I can't figure it out. Any help would be appreciated! TIA

 

[aoram@sunflowerneo.com]

99478-99480 Denials

Our office is also having issues with denials on the same range of codes, 99478-99480. Our denials started happening after 1/1/18. It start with Tricare, then Aetna and now we're having denials with various Cigna products, Great West etc. We reached out to the AAP. They said they were aware of an issue with these codes but at that point only knew of the problem with Aetna. The rep said there was a glitch in their edit system that was causing the denials. Rep seem to think that their system was McKesson? So far we've been able to get Tricare claims corrected and processed (the new Tricare West, HNFS, has been very helpful). Aetna is still working on it. Some of the Cigna's have come through now but we're still having issues with Great West. We've been dealing with this for 4 months and we'd love to find something in writing about this glitch. Would help us a great deal when have to call insurance companies on these denials!