Wiki Help Understanding DX Denials for LCD L34616 & A57480- WPS Medicare

[zee@atozeemhbilling.com]

I am a biller trying to determine why certain diagnosis codes were denied under LCD L34616 and Article A57480. Is there a resource where I can check which diagnosis codes can be billed with specific CPT codes?
We received these denials for several patients, and while reviewing the LCD directly, the diagnoses seem to be covered. However, I am clearly missing something. Since coding research is not my usual responsibility, I want to ensure I am using the right tools to verify compatibility.
Here are two specific scenarios where we received denials:

• • 90791, seen by an LCSW via telehealth – DX: F10.20- this DX was also billed with 90837s (on separate days) and paid in 2024 but is denying in 2025
  • 90792, seen by an NP-C via telehealth – DX: F31.73

Are there additional limitations related to provider type, place of service, or CPT/DX pairing that I should be aware of? What tools or resources do experienced coders use to verify CPT and DX compatibility beyond the LCD lookup?
Any guidance would be greatly appreciated!

diagnosis codes, diagnosis coding

 

[CBLENNIE]

What is the denial reason for these claims? Also, what modifiers and POS are you using since these services are being rendered via telehealth?

diagnosis codes, diagnosis coding

 

[zee@atozeemhbilling.com]

Thanks for responding! Both have the same denial- CO-50: These are non-covered services because this is not deemed a 'medical necessity' by the payer.

They both had POS 10 with a 95 modifier

diagnosis codes, diagnosis coding