Why would I get a rejection for a “Covered” code?
Why am I receiving a rejection on claims for this Dx/HCPCS combination?
The code is 62311, with theDx being M48.07. The LCD module shows this to be covered.
This particular code is found in the list of diagnoses considered medically necessary, but there is additional language restricting the number of injections, which could be the cause of the rejection. And as with all services, regardless of reported indications on a claim, a service may be denied if the medical records do not also substantiate the medical necessity