Medical Billing Forum
Payments => Insurance Payments => : LoveShakthi September 26, 2019, 04:59:32 AM
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Hi frnds.. Bcbs of Arizona denying CPT 96160 as non covered services under pt plan .also paying at some cases.. Called insurance states 96160 is non payable code in state of Arizona... Can anyone help me on this.... :'(
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Is the patient's plan a Medicaid product? It sounds like it is an exclusion on the policy. If you have examples on claims with 96160 where it is paid, see if it's the same plan as the one denied. It may simply be that this specific plan doesn't allow that code.
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denying CPT 96160 as non covered services under pt plan .also paying at some cases
The denial, if stated as you posted it actually tells the story. Sounds like the "patient's plan" is ERISA and that is a non covered service, you can obtain a copy of the patient's SPD to see if you might have grounds for appeal using ERISA. If you can't get patient's cooperation for appeal (SPD, signed ARF) then bill the patient.
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@ PMRNC : Thanks for info....
After some research with pt plans found , Federal state plan of Arizona starts with Policy prefix 'R' denied this CPT 96160 and prefixes with numeric that starts with '850, 851' (ex: SYD850.....,AMR851...etc) are the ones denying this code frequently. If incase behavioral assessment not covered under their plan ...heads up CPT 96127 stands for behavioral assessment is getting paid under their plan... Any views or ideas on this :(
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All federal policies start with the letter R. It still sounds to me like it is a plan exclusion. I'm confused by your post if any of the plans are paying the 96160.