# 36415 denials



## Thouvenel (Oct 26, 2012)

My claims for Cigna and Aetna are being denied for the 36415 when performed with an office visit...the lab bills the lab tests, we bill the venipuncture.  Is anyone out there getting paid for the 36415 for these insurance companies?


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## knimmer (Oct 26, 2012)

Humana is one payor that we do not get reimbursed for 36415. I believe it depends on your contract. If your office recently resigned contracts, they may have added that in there. I would either call the payor to find out their reasoning and appeal the claims.  You might want to have someone discuss this at negotiation time.


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## Roberta P (Apr 19, 2013)

*36415*

I am having the same problem, was contacted by Aetna today and was told that they were going to go back and re-coup all the venipunctures they had paid.  It seems this was changed sometime last year.  I was told that it was made inclusive with lab payments since last year.
Heard nothing about it?? Very upset!!


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## btadlock1 (Apr 19, 2013)

Oddly enough, I think those bundle to the pulse oximeter code, if you bill that. It's a relatively common denial. Where I used to work, we just wrote it off, since the reimbursement was so low, anyways, It could be a group or plan specific denial, but you should ask to see the rationale for it, anyways. Also, for Cigna, this might help (see page 7): http://www.cigna.com/assets/docs/health-care-professionals/807467h-Preventive-Health-Cov-Guide.pdf


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## encomma-watson (May 1, 2013)

*36415*

It might be bundling with the CCI edits.  Medicaid and Medicare will pay for it, but NCBCBS bundles it with the E/M code.  

Good Luck.


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