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medicare bone density

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jenniferp:
Does anyone else here perform/bill for DEXA bone density scans?  (CPT 77080)

All of the sudden we are having difficulties w/billing Medicare for this service for 2020.  The denial is stating it's based on a National Coverage Determination, but I have yet to find the actual NCD that shows the information for 2020 (or an LCD) for that matter.  Has anyone had any issues billing this to Medicare for 2020, we don't do a lot of them, but the few we do, we'd like to be paid for.  I know Medicare had a very small amount of diagnosis codes that were covered, but all I can find now are just indications for the test to be done.

This is for Tennessee btw.

Thanks -
Jennifer

Michele:
The ERA should contain the NCD number.  If you google that NCD number you will find the NCD they are referring to in the denial.  That is the best way to figure out why it's being denied.  :)

jenniferp:
Yeah -- unfortunately it doesn't.  The EOB just states that it's denied based on an NCD.....when I try looking up the NCD/LCD for this CPT code, nothing comes up.

The last LCD/NCD that I had only showed a couple of diagnosis codes that were approved, but one of those that I use is the one that denied.

Thanks -
Jennifer

Michele:
Wow, that's weird.  They usually put the NCD number right on the ERA which is helpful.  Have you tried calling to ask them to point you to the NCD?  Since it's not listed on the ERA they should be able to tell you the NCD number that is causing the denial.

kristin:
Is it possible that the issue is the patient has already had one done within the last two years, therefore, it is not covered? Normally, if this is the reason for the denial, the denial will state that, but I don't know what clearinghouse you are using, and how descriptive their denials are, if that makes sense.

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