01/17/2018

Medicare Rejections-CPT 64455 for DX 657.81 Morton’s Neuroma

Medicare is denying CPT 64455 for Dx G57.81, Neuroma with explanation 50--non covered service because not deemed a medical necessity. Is there a maximum of these injections that Medicare allows? Also, any further word on my earlier inquiry re L4397? Thank you.

The injections were denied for medical necessity because NGS Medicare has a limited number of diagnosis codes that are covered for injections related to Morton’s Neuroma. As per the current LCD policy, below are the only three diagnosis codes that meet medical necessity requirements (https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=36850&ver=14&CoverageSelection=Local&ArticleType=All&PolicyType=Final&s=New+York+-+Entire+State&CptHcpcsCode=64455&bc=gAAAACAAAAAA&):

G57.61* Lesion of plantar nerve, right lower limb
G57.62* Lesion of plantar nerve, left lower limb
G57.63* Lesion of plantar nerve, bilateral lower limbs

Typically, if performed bilaterally, Medicare will allow up to two injections to be billed per day (one per foot). If any additional injections were performed, they may deny for frequency and supporting documentation will need to be submitted with a redetermination to justify the need for additional injections.