Coding, Classification and Reimbursement

Humana denials for CPT 20610

  • 1.  Humana denials for CPT 20610

    Posted 6 days ago
    We are having an issue with Humana denying CPT 20610 saying the modifier is inconsistent with the procedure. We are billing these twice on same claim because we are injecting two different joints on opposite sides of the body ie.... right knee and left shoulder. We are billing 20610,RT and 20610,LT with correct Dx linked to each code. We've called Humana multiple times questioning the denials and what policy they are following to process these claims unfortunately the customer service reps are of no help. We've sent our claims back for reconsideration with supporting to documents (our medical record clearly supports what was performed) only to receive the same denial. We've also added either XS or 59 modifiers but end with same result. We currently have several claims that a Humana rep has routed back to their code edit team for review but their turn around time is 30+ days. Is anyone else having this issue or have any suggestions?

    Lee Ann