TJAlexander
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Hey all,
I have been dealing with an ongoing situation with UHC regarding a knee brace dispensed to a patient (L1832). The claim was initially denied due to lack of documentation. I faxed the imaging report, visit notes and proof of DME delivery even though the documentation was sent with the claim with the initial submission. Then the claim was denied due to 'no documentation of customization'. The brace was prescribed due to rupture of the the right ACL.
I've asked UHC to send documentation of the specific reimbursement/coverage policy used to deny the claim but in my experience (which is admittedly limited), L1832 is not the customizable orthotic; L1833 is. Am I wrong? Has anyone had issue with L1832 denials and if so, can you offer any suggestion as to how to specifically address it in my appeal?
I have been dealing with an ongoing situation with UHC regarding a knee brace dispensed to a patient (L1832). The claim was initially denied due to lack of documentation. I faxed the imaging report, visit notes and proof of DME delivery even though the documentation was sent with the claim with the initial submission. Then the claim was denied due to 'no documentation of customization'. The brace was prescribed due to rupture of the the right ACL.
I've asked UHC to send documentation of the specific reimbursement/coverage policy used to deny the claim but in my experience (which is admittedly limited), L1832 is not the customizable orthotic; L1833 is. Am I wrong? Has anyone had issue with L1832 denials and if so, can you offer any suggestion as to how to specifically address it in my appeal?