Author Topic: Medicare pays all but implanting titanium disc  (Read 3783 times)

ddgypsy

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Medicare pays all but implanting titanium disc
« on: February 22, 2016, 09:44:35 am »
Has anyone had this problem?  Person I talked to at Medicare states my BAHA is durable medical equipment, she was quite rude insisting this.  But they paid for the processor, the doctor, recovery, anesthesia.  They denied the implantation and the anesthetic medication. This makes little sense. The hospital says they have appealed twice, but they used the wrong code the first time and Medicare recommended a different code which was denied also. Both codes were not the ICD9 code Cochlear Americas stated should be used.  Now, I am about to be sent to collections for $10,200.  I am gathering information and need the Medicare statement/documentation from November 3, 2014 where they said these prosthetic devices will continue to be covered.  I cannot access it on my computer, it says it does not exist, have asked another to try also.   Does anyone have a copy they can send me!!?? Please. Any other suggestions?  I will approach Medicare again, but think that is a process.  And I will go higher up the ladder in billing at the hospital.  I work almost full time, so this is difficult to find time to talk to and call people.
2.5 cm left , translab, May 2000
BAHA April 2015

arizonajack

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Re: Medicare pays all but implanting titanium disc
« Reply #1 on: February 22, 2016, 01:37:59 pm »
I found a web page from ASHA that included the question "Does Medicare cover BAHA?"

http://www.asha.org/practice/reimbursement/medicare/medicare_faqs_aud.htm#8

Here's a pdf of the CMS document dated November 2005.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R39BP.pdf

The Medlearn Matters Article also addresses BAHA and appears to list the required coded for providers to use.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM4038.pdf

Another item came up in my search. It addresses BAHA, is dated 2008 and is from the CMS Claims Processing Manual:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1470CP.pdf

I haven't found anything dated November 2014.

I hope that gives you all the information you need.
« Last Edit: February 22, 2016, 01:49:27 pm by arizonajack »
3/15/18 12mm x 6mm x5mm
9/21/16 12mm x 7mm x 5mm
3/23/15 12mm x 5.5mm x 4mm
3/13/14 12mm x 6mm x 4mm
8/1/13 14mm x 5mm x 4mm (Expected)
1/22/13 12mm x 3mm (Gamma Knife)
10/10/12 11mm x 4mm x 5mm
4/4/12 9mm x 4mm x 3mm (Diagnosis)

My story at: http://www.anausa.org/smf/index.php?topic=18287.0

james e

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  • 69 years 1.7cm, trans lab Mar 2010, BAHA 5
Re: Medicare pays all but implanting titanium disc
« Reply #2 on: February 26, 2016, 03:34:06 pm »
Working with the Feds is FUBAR. Here is what has worked for me in the past. Go to your local congressman's office, and have them check into it. Do you know the name of the person you talked to at MEDICARE? Do you have a secondary insurance company? If you do, what do they cover?

I always win when I use my congressman, even against the IRS. This is an election year and they are always happy to earn your vote.

 


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