Q: As an oral surgeon, I have been a Medicare provider forever and have not been able to bill anything other than pathology and occasionally trauma. Years ago, we tried to bill 21248 and 21249 with no result.

A: The issue lies in one of the following areas:

These codes are routinely payable but if you have tried to do the billing yourself, payment isn’t predictable.

2. See the previous discussion on this. It is in your best interest to swallow your pride and follow the lead of the medical surgeons who use expert third-party billers to get paid. It’s basically impossible to get paid without ongoing, expert, third-party help, especially in the wake of rule changes starting in 2020.

3. Not following administrative steps required by Medicare. This can be related to specific rules governing submissions in your MAC, improperly prepared compliance documents that upon submission to a CMS request result in a claim denial, and improper coding that also results in a denial. Unless an expert knowledgeable in how to navigate denials in your jurisdiction is working on your behalf, you will have a very limited chance of moving past claim denials.