I have had my recent insurance claims rejected because the codes I have submitted for the G6 sensors and transmitters are wrong and apparently were changed last year sometime. In the past, I used A9276 and A9277. My insurance company won’t tell me what the new correct ones are, Costco Pharmacy couldn’t help so I put in a call to my HCP to find out what the correct ones are.
For those of you who submit your own claims, have you experienced this problem? What codes have you been using (successfully)??
Those are still listed as valid hcpcs codes for 2021.
Did you get from DME supplier before, but now using Costco Pharmacy benefit? May need different code for pharmacy or the RX number.
I get mine from Costco and they are able to directly process with my insurance, but many many years ago I had to do mail claims. (Before pumps and cgm).
I stopped using a DME supplier in Oct 2019 and have been using Costco ever since. Since switching to Costco, I have filed the claims myself just to save time and avoid the hassle of having Costco get updated documents from my endo, which has always taken forever. I may have them submit directly to my insurance from now on.
The only codes the DME or I ever used are the same ones you are using but I just noticed on my recently updated CMN that the old codes (A9276 and A9277) and the new ones (K0553 and K0554) are all listed together. My endo just confirmed that the KXXX codes are the correct ones.
I’m sure many of you probably do this, but I just want to commend you for submitting your own claims. I, myself, am a firm believer in if you want something done right - do it yourself. But I don’t think I’d have the patience to do this for myself!
I used to work in pharmacy for about 7 years, so I think that might be part of my disdain for insurance claims.
Ha Ha!! Until I started dealing directly with Tricare, I would have agreed with you 100%. But I have had nothing but problems with all my claims since I moved from CA to WA - even the reimbursement amounts are different due to varying “State Prevailing Rates” and it has been a complete nightmare. When they kept rejecting my recent claims, one of the reasons was that the wrong codes were used. That implies an existing code was used erroneously. What they should have said was that the codes had changed and that I needed to get the new ones from my HCP. I didn’t get this detail until I had called at least half a dozen times. But lo and behold, the correct info was there all the time because the CMN lists both the old codes (AXXX) and the new codes (KXXX) !!!
So I am now considering ending my career as a medical insurance billing specialist and handing it over to the lovely people at my local Costco Pharmacy.
