Insurer has denied billing for code '97112' in treatment of diagnosis code '825.25' stating "Claim or charges denied because procedure/treatment is deemed experimental" Any suggestions on how to appeal this determination or a better cpt code to use. The Therapist maintains that Neuromuscular Re-Education which includes: balance, proprioception, coordination, & kinesthetic is appropriate for rehabilitation of a 3rd metatarsal head fracture (dx code 825.25)
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- Posted by Clarence Cartwright 1 year ago. There are 2 posts. The latest reply is from Carmen Colon.
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Use cpt-97110 it will pay out, anything to do with exercise will. Do not focus on the re-education. That fact is
the therapist is giving therapy. It will not pay more for re-education believe me. Good Luck
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