06/18/2024

Aetna-Denial for CPT G0465

How do we bill G0465? We submitted a claim to Aetna, code has diagnoses for both chronic ulcer and diabetes mellitus, but it's still denied for not having been proven effective. Is it simply not covered by Aetna and there's no way around it or is there a way to get it paid? And Medicare, do they cover this code with the two required diagnosis?

Aetna will not cover injections billed under G0465. All plans consider this service to be experimental and not medically necessary for patients. Most commercial insurance carriers, such as Cigna and UnitedHealthcare, also consider the procedure as non-covered. Medicare is one of the few payers that will cover the service. The local Medicare contractor for New York does not have a specific Billing and Coding Article- There are no specific codes that need to be submitted to justify medical necessity.