Wiki United Healthcare denying payment for pessary device

[KJOHNSTON]

We are having trouble getting United Healthcare to pay for a pessary device which we purchased for the patient and inserted in our office. They are saying the reimbursement for the device is included in the reimbursement for the fitting. I'm wondering if, perhaps, there is a modifier we should be using. Any help would be appreciated.

 

[Deborah Marsh]

Hi - I found this policy: https://www.uhcprovider.com/content...ies/comm-reimbursement/COMM-Supply-Policy.pdf

There is an attachment with "A List of HCPCS supply codes not separately reimbursable in an office, non-facility, or facility place of service." https://www.uhcprovider.com/content...chments/reimbursement/Supply-Policy-Codes.pdf

Pessary codes A4561 and A4562 are on the list. If the reimbursement isn't sufficient to cover the supply and service cost, some suggest providing the patient with a prescription to purchase the pessary directly from the supplier and then bring it to the office for the insertion.