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Tricare and C9358

Ann Posted Wed 19th of January, 2011 20:59:06 PM

I am having trouble getting a claim paid. I billed C9358 with 600 units. Tricare is allowing 4 units stating it is over the Maximum amount of units. Has anyone had this problem? I cannot get anywhere with my Tricare rep. They just continue to tell me its in Chapter 13 of the ASC Reimbursment Manual, but it's not. Thank you for any information.

SuperCoder Answered Fri 21st of January, 2011 05:12:26 AM

Need to submit medical necessity that justifies using 600 units of C9358 that the specific treatment option demands with proper document with letter of appeal to get it reimburse. If still it qualifies for less units, then you can consider it as a payor-specific criteria of reimbursement of C9358

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