Posted in Insurance, Payers and CPT reinbursement, Training

Anthem BCBS Plans and CPT code 95012-updated medical reimbursement policy.

Is your private office practice seeing an increased number of denials for CPT code 95012? Well, maybe this is the answer why.

Some history for the CPT code 95012 first:

FENO (or NIOX) – CPT code 95012, has not been the most popular code amongst payers. In the last 5 years some payers listed in their medical policies that it was an investigational  and is not considered medically necessary.

Insurance payer 1199 has paid only for 2 (TWO ) of the CPT 95012 per 1 (ONE) year.  In early of 2019- payer SEIU 1199 changed its policy and is now paying for CPT 95012 when done more than 2(TWO) times per 1 (ONE) year.

However, this is about the most recent change. The change that was published on 02/27/2019 by  Anthem BCBS. Local plans like TUR, MFX, MYF-are affected.

The following is the Medical Policy Position Statement:

” Investigational and Not Medically Necessary: The measurement of exhaled nitric oxide or nasal nitric oxide is considered investigational and not medically necessary in diagnosis and monitoring of asthma or other respiratory disorders.” This is followed by a lengthy rationale and the cpt codes including the CPT code 95012.

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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