New BCBS Policy 115 for transthoracic echocardiograms

[amcghee]

Has anyone been experiencing denials from BCBS for 93306, TC? On 10/01/24, they implemented a new medical necessity policy and all of our claims are being denied no matter what diagnosis we submit. I called BCBS and they do not have a list of covered, medically necessary codes. You basically need to read the policy and medical verbage and choose a code. I'm wondering if it's an internal problem with BCBS?

 

[jodielonkoski]

I have not had this specific problem, but in general my office has an insane amount of problems with BCBS (our local plan anyway) not following their own policies or denying for seemingly no reason. Good luck

 

[catherinetinkey@entmedicalservices.org]

First what state is the BCBS. I see a policy 115 for BCBS Massachusetts, that policy does contain medically necessary ICD-10 codes and it also states when the procedure is deemed medically necessary and has a link to medically necessary codes-- A56781 Billing and coding Transthoracic Echocardiography (TTE) diagnosis codes. It is not deemed medically necessary for routine screening.

diagnosis codes, diagnosis coding