Hello Everyone,
We recently billed L7510RTK3 x 1 unit for a replacement locking pin for a
patient. Medicare originally denied the claim due to “This service/procedure
requires that a qualifying service/procedure be received and covered”. So we
submitted a Redetermination with documentation proving that Medicare covered the
initial prosthesis and that this service should be covered as there was a
“qualifying service/procedure be received and covered” so this service should be
covered as well. The documentation also stated the medical necessity for the
replacement locking pin.
Now, they have denied our Redetermination; however, the denial reason has now
changed and I have never experienced this denial reason. The new denial reason
is “The locking pin (repair or replace) (L7510RTK3) is not covered because there
is liability insurance with the matching primary diagnosis”. So, I called
Medicare and the not-so-helpful gentleman who I spoke with informed me that I
needed to go to Reconsideration based on the information I received in the
letter. When I told him that I am fully aware of the appeals process but that I
have no idea what this denial reason means, he simply told me to state that in
my Reconsideration and state again why we feel this service should be covered.
Before I call back and try to get someone who might be a little more helpful,
has anyone received a denial like this and have a better understanding of what
in the world it means? The patient doesn’t have any other insurance other than
Medicare. Medicare has covered L7510 for other claims for this patient. I am
at a loss and would appreciate any input anyone may have.
Thanks so much!
Melissa Bolton
Funding Assistant
Real Life Prosthetics
