11/16/2022

Aetna Bundling Denials for RFC

Medicare pays routine foot care coding. Combinations of 11056 and 11720/11721 are reimbursed as long as diagnosis codes and modifiers are listed correctly. Using the exact same coding combinations with Aetna and EBCBS HSA(Medicare HMO) I am finding that the codes 11720 and 11721 are being rejected. My assistant called both companies and they stated that these codes can not be billed together. Do you have any suggestions?

This is a common problem with Medicare Advantage plans like Aetna and Blue Cross with routine foot care coding. If denials are received bundling one of the RFC procedures, the only recourse at this time would be to initiate an appeal with the insurance. Supporting documentation from the patient’s chart or EMR needs to be printed and sent to the insurance to justify the billing on the claim for additional payment to be made. Appeals can be mailed,, faxed, or uploaded to an insurance portal, depending on the payer in question. Appeals should be sent as soon as possible once as denial is received to the respective insurer for review.