97112 Neuromuscular reeducation reimbursement

[Guest guest]

I originally posted this to the Peds list serve as it has been a primarily

pediatric issue so far. Another member of these list serve(s) saw it and

requested I post it on these as well. I have gotten one response for m a

pediatric PT in the Northeast, who had a problem before she went to a contracted

rate per visit with a BCBS provider.

I will be gathering articles etc. I have let APTA know about it but have not

heard back from them as yet.

BCBS of Tennessee is Not my Medicare intermediary so have not had this problem

with Medicare patients or other payers.

Original post:

We have been having some difficulty with BCBS of Tennessee with reimbursement of

the 97112 code. I have been working with our contract/managed care staff on

this issue. Basically, BCBS Tennessee is denying 97112, neuromuscular

reeducation and state that it is investigatory

This is the quote via email:

" 97112 also exists as a fee schedule item in all of our networks; for

example, CPT code 97112 is set at $24.77 in the BluePreferred fee schedule.

However, because it is considered investigational we end up not paying for it.

There are other codes like this where the BlueCross Association Technology

Evaluation Center or the BlueCross BlueShield of Tennessee Technology Evaluation

Group has determined that a technology, process or procedure that is billable

just does not provide any benefit to the people that receive it other than the

fact that they have had someone to talk with during the time the process or

procedure is applied. "

Has anyone else had problems with any BCBS for 97112? The guy at BCBS Tennessee

is implying that it is a national policy.

Any Help or ideas out there?

Pat

Pat Corrigan Jobes, PT

Director of Rehabilitation Services

Methodist Healthcare-North Hospital

3960 New Covington Pike

Memphis, Tn 38128

Phone: (901)384-5320

Fax: (901)384-5099

E-Mail: jobesm@...