Re: Anthem BCBS What code to use for DME?

[Guest guest]

If you can't find a code, I think you can have your provider send in a written

explanation of the band and it will be reviewed by the medical policy

department.

I have Oxford and I think CT used the same E1399 code but they sent in a

detailed explanation of the band and treatment along with the medical necessity

letter from the doctor and it was approved to pay. I think most insurance

companies work along the same lines. Sometimes codes do not exist for

all DME equipment, especially for something that is new and not used

often. With the increase use of these bands, they will probably have to

make a new code soon. But until then, providers have to send in a

written explanation.

ann/

NJ

DOCband 2 weeks

> Message: 6

> Date: Wed, 10 Jul 2002 12:38:30 EDT

> From: hags1@...

> Subject: Re: Anthem BCBS What code to use for DME?

>

> I work for BCBS and the E1399 is a generic dump code that they use for all

> durable medical equipment. So the reason they won't look at it to pay is

> that it could be anything that is classified as durable medical equipment. So

> if they billed it and it is for a large amount under that procedure code it

> will kick out and they won't pay a generic item that is that much. There

> should be another code that they can use? I am not sure what it would be I

> will have to look and see what they billed my childs helmet under? I believe

> it was a code that began with an L.

> and Grace

>

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