MAY 19, 2016
Denial for Intravitreal Injection with Laser Procedure
Question: A commercial payer denies payment for CPT code 67028 Intravitreal injection when submitted with CPT codes 67210 Focal macular laser or 67228 Panretinal photocoagulation. The injection was made in the same anatomical site, but not through the same incision or surgical approach. Can you provide any assistance as to why they denied these claims?
Answer: The commercial plan seems to be following the "separate procedure" language and bundling the services. Some commercial payers interpret this separate-procedure language to mean a stand-alone procedure. However, Medicare Part B follows the CCI edits, for which there are none with this code combination currently.