12/21/2023

Correct Billing for CPT 10140

Medicare denial for 10140 with icd 10 S90.421A. CO-50 non-covered service because not medically necessary

The service was denied by Medicare because the minor surgery is only covered by Medicare with specific diagnosis codes. Per the coding article, the injury diagnosis billed is not covered by the Medicare contractor. Since the specific diagnosis is not on the policy, Medicare will not pay for the service. A redetermination can be filed if supporting documentation can be submitted to justify the medical necessity of the procedure. The coding guidance can be found here:

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56766&ver=13&keyword=&keywordType=starts&areaId=all&docType=6,3,5,1,F,P&contractOption=all&hcpcsOption=code&hcpcsStartCode=10140&hcpcsEndCode=10140&sortBy=title&bc=1