05/04/2021

Wellcare Denial for RFC Bundling-11721 & 11056

WellCare denying 11721 with 11056 on same toe even though the callous paring is located overlying the 1st toe's PROXIMAL phalanx

These types of denials are becoming increasingly common with Medicare advantage plans- even with coding that would be covered and medically necessary to traditional Medicare, plans like Wellcare are denying a portion of charges as bundled. If the documentation supports separate reimbursement for the procedures, they should be appealed to Wellcare. Submitting an appeal is the only recourse that providers have currently as we work with the different Medicare advantage plans that are bundling routine foot care charges incorrectly. Attached is the appeals form to file with Wellcare that should be sent with all pertinent documentation.