Urology Coding Alert

Question: Can we expect reimbursement for CPT 86294 ?

Answer: Use 86294 (Immunoassay for tumor antigen, qualitative or semiquantitative [e.g., bladder tumor antigen]) for the bladder tumor antigen (BTA) or nuclear matrix protein (NMP)-22 testing kits, and you should be paid.

Caveat: Remember this is a Clinical Laboratory Improvement Amendments (CLIA) waived study, and you must add modifier QW (CLIA waived test).

Medicare reimbursement will vary by state from $11.93 to $27.61.

If your practice has CLIA-waived status, you can perform (and bill for) these tests. For your practice to perform CLIA-waived testing, Medicare requires that you:

• Enroll in the CLIA program by obtaining a certificate and pay the certificate fee every two years.
• Follow the manufacturers' instructions for the waived tests.
• Notify your state agency of any changes in ownership, name, address, or director within 30 days, or if you wish to add tests that are more complex; and allow inspections by a CMS agent, such as a surveyor from the state agency (Your laboratory is not subject to a routine survey or inspection).