Labyrinthotomy place of service

HealthNet had denied our charge for 69801 Labyrinthotomy stating it is not payable if done in an office setting. Per CMS policy. Medicare does show an allowed amount on their fee schedule showing a payment amount when this is done in an office setting. Medicare does not even show an allowed amount if done in a facility setting. What other ammo can i use to show that this procedure can and is done and an office setting and payable if done in an office as well.

69801 Labyrinthotomy

Medicare does indeed allow in the office for 2011 so you should appeal the denial - this was a change in 2011. The private payors may not have changed their policy yet for 2011 CPT® and Medicare changes.

Kim Pollock, RN, MBA, CPC
KarenZupko & Associates, Inc.
www.karenzupko.com