02/25/2021

Wellcare Denials for 11056 and 11721

WellCare is being Denied. Submitted 11056Q9 and 1172 159Q9 for 2021 excuse for denial is NCCI denial due to mutually exclusive coding validation. They paid these codes back in November 2020.

This an increasingly common issue that is being seen with many Medicare Advantage plans. Even with medically necessary coding that would be paid by Medicare or other plans, insurances such as Wellcare are denying the lesser of two routine foot care services if more than one procedure is performed per day. The only way to dispute this partial denial is to submit an appeal with the progress notes from the DOS. The supporting documentation should justify the correct use of modifier -59 on the submitted claim and overturn the CCI denial that caused 11721 to deny inclusive to 11056.