10/18/2021

UHC Denial-Strapping

we are being denied Strapping 29540 by UHC there denial is as follows : Your denial Rationale CPT code 29540 remains not supported, According to CPT code guidelines. Strapping CPT codes shall not be reported for application of a dressing after therapeutic. Therefore, the billed service cannot be supported . We are billing 97022 and 97035 Ultra sound and whirlpool along with Strapping . We know we can bill these codes together and have correct modifiers assigned. Medicare has already approved and paid these claims, But still UHC-Empire is denying for the above reason, What is the best way to handle this ? We have been denied at the 1st appeal level already. Thank You

The coverage guidelines for Medicare and commercial payers such as the Empire Plan/United Healthcare can differ and may not have the same coverage criteria for the same service modalities. For the Empire Plan/United Healthcare, below are the coding recommendations for justifying separate payment:

• The ultrasound and whirlpool therapy should be billed on one line item per modality for the treatment the patient received, with the appropriate number of units for each service. For CPT codes 97022 & 97035, each of these therapy services should be billed with the -GP modifier to show that these services are part of an outpatient physical therapy plan.

• The strapping should be billed (if possible) with a diagnosis code distinct from the PT modalities to substantiate separate payment. The strapping should not have a -GP modifier; if it is billed with this value, it will cause this portion of the service to deny again as a therapeutic adjunct to the therapy modalities. It should be reported with modifier -59 primary and the site modifier secondary. If being applied bilaterally, be sure that modifier -50 is reported in lieu of site modifiers since the Empire Plan/United Healthcare will only cover one unit of service per day/per patient for strapping.