Appeal help

We recvieved a denial from Anthem for procedure code 15420 with a 59 modifier. The denial states "Devices that are investigational or experimental are not covered".
Looking for help with appeal. Has anyone appealed for a similar denial and had success?

Appeal help

What were all the CPT codes you submitted that day? If you used modifier 59, there must have been another procedure.

Give us all the CPT and ICD9 rules.

sorry, you gotta know yor carrier rules

Read here: http://www.anthem.com/medicalpolicies/policies/mp_pw_a053309.htm and search for 15420- not covered

Brilliant

Thanks for looking this up.

Code info

Thank you for the link, I will be able to share this information with our physicians.

Codes billed

57240 & 15420 -59; dx 618.4.