Wiki Allowed Codes

[AmandaM2153]

Hey Everyone ---

So I keep getting codes back because they are now allowed by Medicare, how do I find out these before they are submitted? Also one (CBC) is denied because it says Medicare doesn't allow it but since when is that??? I am new to medicare billing and need help!!

Thank you,
Amanda

 

[dclark7]

You can get most of the information you need from either your MAC's or CMS' websites. Your MAC will have any LCDs (local coverge determinations) for your area which will give you coverage criteria and limitations. The CMS website will have NCDs (national coverge determinations) as well as their MedLearn section. Try to spend some time just looking around on the websites, you'll find alot of information.

 

[cheermom68]

For the CBC, if you are just drawing the blood and sending to an outside lab, under MC guidelines the lab would have to bill for the CBC not the physician. Pass-through billing is not allowed.

 

[AmandaM2153]

Yes we do not bill straight Medicare for our outside labs, but this was an HMO that denied it and said they did so because they follow Medicare G/L's.

And does Medicare have a place to sign up for email updates?

And sorry if I sound stupid (still learning Medicare) but what is MAC's?

 

[ctrueblood]

Medicare Administrative Contractors (MACs)

Hi Amanda,

Your MAC depends on your state. It's where you bill and get paid for your Medicare services. Here is a link to the NCD's for covered labs.

http://www.cms.gov/medicare-coverag...tails.aspx?NCDId=61&ncdver=1&bc=AgEAAAAAAAAA&

We are in WA, we use Noridian Administrative Services. I have to look at both their website and CMS.gov to find what I may need. You need to practice searching for allowed and payable CPT's and DX's on these sites.

You should be able to sign up for Medicare updates thru your MAC and/or CMS.

Good luck, but as a rule Medicare is very picky about which labs they consider medically necessary and payable. Hence, why you get the patient to sign the ABN's upfront, so they understand that Medicare will not pay for it and it's patient resp.

Cynthia Trueblood, CPC

 

[kvangoor]

I would also check to see if you have your CLIA ID attached to the lab CPT. That could be a reason for the denial.