Wiki WellCare in CT denying CPT 93224

[manastasio]

Is anyone having any issues with Wellcare denying 33249. We had to use the Q0 modifier and the dx 425.4 they wont pay for it stating it is experimental and part of a clinical trial. I appealed and they still wont pay.

 

[cgbar]

This is for CPT 33249. If the Dx is NICM (greater than 9 months), then NYHA Class II or III CHF is also needed per CMS guidelines for an ICD as well as an EF of < or = to 35%.

Lots of hoops to jump through for these devices.

Glenn

 

[manastasio]

I bill 33249 to Medicare this way and they pay for it. It is only Wellcare denying and they are giving me a hard time. Havent told me what is needed to correct the claim according to their guidelines