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90670 denial from Medicare

We’ve had a few denials from Medicare for billing 90670, since it’s supposed to be given once per lifetime only. They’re mostly new patients and they forgot or were not aware that they’ve already received that shot before. Our rep said we can appeal those especially since they were not in their previous PCP’s records, too. But those we have sent appeals for were again denied.

What are your experiences with this scenario? Have you successfully overturned a 90670 frequency denial before? Do we move on to the second level of appeal?

Medical Billing and Coding Forum