Medical Billing Forum

Coding => Coding => Topic started by: Eyore on January 12, 2016, 12:45:05 PM

Title: 97035 deemed experimental
Post by: Eyore on January 12, 2016, 12:45:05 PM
and non-payable by BCBS with DX M26.61 help
Title: Re: 97035 deemed experimental
Post by: kristin on January 12, 2016, 07:11:44 PM
You need to check the BCBS LCD on 97035, and see if M26.61 is a payable dx. I can tell you that it isn't with my Medicare carrier, so that doesn't bode well. If it is considered experimental, and not covered, you can try to appeal it, but it will be difficult. This could end up being a self pay situation for the patient. Not every service is covered for every diagnosis, which is where pre-certification comes in handy.