06/21/2021

Humana Denials for CPT 11720/11721 & 11055/11056

humana has been denying 11720/11721 with 11055/11056 codes. what is the recourse? Send bills through the mail with the notes?

The only recourse that providers have at this time is to submit an appeal to Humana with all supporting documentation to support billing multiple procedures on the same claim. Humana historically has been notorious about denying routine foot care charges that are billed with an E&M code, a minor procedure, or other RFC charges. Even if they have identical coding for what would be billed and reimbursed by Medicare or commercial payers, Humana will still deny charges. Since the insurance does not have a formal appeals form, it would be best to either fax or mail the notes to the payer for review. The notes should be as detailed as possible to support the coding submitted on the claim for the best chance at having the denial overturned for additional payment.