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Jeannie Posted Tue 23rd of June, 2015 12:14:15 PM

Are these codes considered experimental? I got a denial from Tricare stating they are experimental. If so can someone help as to where I can find this documentation. thanks

SuperCoder Answered Wed 24th of June, 2015 01:02:33 AM

As i can search, these codes are investigational/experimental. It is payers responsibility to provide the medical policies which states that these procedures are investigational/experimental with reasoning. You should ask Tricare to provide those medical policies. Ideally, you should ask the patient to sign the ABN for these services. Experimental/Investigational services are defined as a treatment, service, procedure, facility, equipment, drug, service or supply (“intervention”) that has been determined not to be medically effective for the condition being treated. Charges submitted for these services listed on this policy should be denied as experimental/investigational.

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