05/04/2021

Fidelis Denials for 73620

I've received 2 denials from Fidelis for x-rays (73620) using the diagnosis code M72.2 and pain in foot and one denial using the diagnosis M20.21. Fidelis paid for the visits and stated the "diagnosis is invalid for the CPT code". I contacted Fidelis and was told that Centene Insurance does not recognize plantar fasciitis as a billable code for x-rays. Can this be correct?

The denial is incorrect- any of the diagnosis codes listed in the inquiry are appropriate to bill for an x-ray. If the codes were billed to any other insurance, they would be covered without any issues. Ever since Fidelis Care has lifted authorization requirements for podiatry, they have been denying these x-rays incorrectly. This has been affecting a number of members where regardless of what codes are being billed, Fidelis is not covering the diagnostic test. The organization is aware of these excessive, incorrect denials from the managed care plan and is currently reviewing the issue with the plan.