A9273 and L0625

[Chiro Billing Collect]

This pertains to New York state worker's compensation fee schedule for DME. I have been billing these codes from the fee schedule and continue to get denials stating they are not on the fee schedule (mainly from work comp carriers). Most no fault carriers will eventually pay after reconsideration but usually deny the first time. The problem codes are:

A9273-cold pack given to the patient to take home
A9900-miscellaneous DME (used for cold pack sleeves given to the patient to take home)
L0625-lumbar brace

All claims are sent with a copy of the invoices as instructed. Any ideas as to why it is such a problem to get them paid? Thank you in advance. Marisa

[Michele]

The A9900 being a miscellaneous code can be an issue but if you are attaching the invoice should be ok.  The other two codes do appear on the NYS WC fee schedule, so I'm not sure what the issue is.  Are you having a problem across the board or only with a specific carrier?

[Chiro Billing Collect]

More so with Work Comp carriers as opposed to NF companies. There are several that will pay the first time. Most of them deny immediately and a few of those will eventually pay after several reconsiderations, appeals, and phone calls.

[Michele]

Well if they pay some then clearly they are on the fee schedule so that is a BOGUS denial.  Unfortunately the only thing you can do is to continue to follow up on them to make sure they pay.  Maybe you could design a template appeal letter that you can simply attach to resubmit when they are denied.  It might save time.