URGENT MESSAGE REGARDING TRAILBLAZER HEALTH FROM THE REIMBURSEMENT
COMMITTEE


Effective January 1, 2006 Trailblazer Health enacted a modified
Local Coverage Determination ( LCD). The most recent LCD contains
two major changes - the new Utilization Guidelines and a list of ICD-
9 Codes that Support Medical Necessity. This list or "crosswalk"
pairs specific CPT codes with specific ICD-9 codes. Recently,
therapy practices have began to report denials ( "Denial Code CO-50 –
These are non-covered services because this is not deemed
a "medical necessity" by the payer") based on the new "ICD-9
crosswalk". It is IMPERATIVE that your office familiarizes itself
with both changes but most importantly the ICD-9 Code listing. These
denials are currently not being corrected through the re-opening
process by phone and require appeal through the redetermination
process. The APTA has been very active in responding to these
changes and in crafting information to assist you. More detail will
be sent to you in email format from your District Chairs which will
contain links to the current LCD, the ICD-9 Code Listing, and the
forms for initiating the redetermination process. Once you have
reviewed the email, if there are still questions, please contact
Angela Brooks at angelasbrooks@....