Denials for CPT 95930

[KellyM]

We are receiving denials for CPT 95930 for any and all dx codes submitted. When trying to find a LCD or NCD for this code I'm finding nothing. This was not an issue in 2016. Any help will be appreciated

[jpways]

I've have this happen with, not exactly the same code but similar situation (the latest one for me was Fundus Photography for Diabetic Retinopathy). You have to file an appeal of medical necessity. Where you have to find LCDs for other insurances, any articles in either journals or books to support your claim. Much of time, the first level (internal appeal inside the insurance company) will fail and you have to request a second level (independent contractor) appeal and hope that they agree with you.

Also if you can find an LCD from a Medicare region other then your own, include that too. In most of the articles I've read about filing appeals of medical necessity it's one of the things that all authors will list as a thing to include.

I've had to do a lot more of these in the last 6 months then I've done in the previous 6 years.

On a side note I'm surprised how in the past 12-18 months many of the NCDs and LCDs I used to commonly refer to have disappeared in my Medicare region. I can think of at least 5 I used an a fairly regular basis and the only one that's left is the Refractive lenses LCD.

[KellyM]

Thanx for the reply. It's some comfort to know that I am not the only one having this issue. I even contacted our local MC payer and they can't bring up the old or new LCD's.