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Robbie Posted Fri 01st of November, 2013 14:09:26 PM

'76942' it is unbelievable how Horizon and Oxford are profiting from this CPT denial, based on "a provider of this specialty (Physical Medicine/ Rehab is not privileged to performed this procedure". The appeal process is a waste of time. How to approach this issue successfully?

SuperCoder Answered Fri 01st of November, 2013 17:39:54 PM

This sounds like a 'scope of practice' issue. Why are you performing a '76942' in a physical medicine/Rehab setting? What is the medical necessity? Thanks. Perhaps you are using the wrong CPT code, what procedure is being done?

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