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Maggie Posted Tue 05th of August, 2014 20:53:02 PM

I billed 99213-25, 3 units 95017, and 20 units 95018. Practice I am billing for is in IL, NGS is my Medicare processor. I am not getting paid for 95018, I have checked diagnosis for medical necessity, 477.9 is listed on LCD. I am getting a rejection for frequency, and number exceeds max. However I cannot find any documentation that states what the limiting amount is. Any ideas?

SuperCoder Answered Wed 06th of August, 2014 08:07:04 AM

Thanks for your question. I agree that there is limited information available regarding frequency limitations for 95018. Your diagnosis is on the LCD and should not be the issue. Medicare does limit the billing of allergy testing within a three year period. The CMS documentation does state that retesting within a three year period is unusual except in children with negative test results but persistent symptoms. It goes on to state that you may submit documentation to support medical necessity. Not sure if this is the case but this is normally the case when you run into frequency issues; the patient has had the services within a certain time frame. See below link for additional information. Hope this helps!

http://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=30471&ContrId=147

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