Wiki Need help: age limit denial for maternity care

[jebond123]

I have recently received a denial for cpt code 59400 (professional global maternity care with vaginal delivery) due to our patient's age (58).
I had initially checked with her insurance(Anthem BX) to be sure they would cover her pregnancy. The response I received from payer chat was that there is no age cap for maternity benefits.
Throughout her pregnancy, I have submitted urine dips & nst's with icd10 codes for pregnancy and been paid. The rep today told me that the age limit for 59025 is 63 but the age limit
for 59400 is 55. He kept insisting that I should just resubmit a corrected claim with a different cpt code and Icd10 code.
I need advice on how to proceed.
Thanks in advance for any suggestions.
Janet Bond

 

[nielynco]

I have recently received a denial for cpt code 59400 (professional global maternity care with vaginal delivery) due to our patient's age (58).
I had initially checked with her insurance(Anthem BX) to be sure they would cover her pregnancy. The response I received from payer chat was that there is no age cap for maternity benefits.
Throughout her pregnancy, I have submitted urine dips & nst's with icd10 codes for pregnancy and been paid. The rep today told me that the age limit for 59025 is 63 but the age limit
for 59400 is 55. He kept insisting that I should just resubmit a corrected claim with a different cpt code and Icd10 code.
I need advice on how to proceed.
Thanks in advance for any suggestions.
Janet Bond

Not only appeal to the medical director - with a scathing letter from your provider to said person, but also report it to ACOG, the newspapers and your state insurance commission. The "he" has no idea about pregnancy obviously and Anthem needs some training as well.