mmyhand
New
My oncology office has received a denial from Humana for Keytruda (J9271) as part of a patient's treatment regimen, citing reason code CO-B15 with the remark "The required initial service for this drug was not processed, received or allowed." J9271 was billed with a clinic visit (modifier 25 appended) along with two pre-medications and CPT codes 96413 and 96375. All other codes on the claim were paid; J9271 was the only denial. Has anyone else seen this denial come up when billing J9271 or other chemotherapy drugs in the office setting? This is the first time I've seen this code denied with that explanation, but I'm unsure what initial service for the drug they could be referring to. Any help appreciated!