12/06/2021

BCBS Denial for 73620

Blue Cross Blue Shield is denying 73620 RT with Diagnosis code M21.41 73620 LT with Diagnosis code M21.42 Stating routine diagnosis code not covered. Is this correct?

The denial from Blue Cross is valid for the x-rays. Because there is such wide variety of different Blue Cross plans, there are some policies (usually for large employer groups, also known as national plans) that have limited benefits for patients. Even though they may have coverage, they may only have coverage for injury diagnosis, or other limitations that would exclude minor chief complaints that would be considered “routine”.

Since it is hard to grasp what Blue Cross plans will cover, it may deny as routine or not medically necessary. It would be best to determine if an alternate diagnosis can be billed. If the documentation does not substantiate an alternate diagnosis, the patient should be billed for the non-covered service since Blue Cross deems the x-rays as a routine service provided by a participating provider.