Wiki Domemary

[DOMEMARY]

Provider wants to bill Mcare for the following CPT code, but Labcorp says the DX code won't work. Here is the CPT code and Dx code he wants to use:

81241--Factor V Leiden---DX code D68.51

I looked up the LCD and this policy was revised 4/16 with No specific DX, and is says Non-Billable/Payable. If anyone has billed Mcare, was it paid or billed to the pt, we have been told this test cost about $300.

Thanks
Rosemary Hoormann,CPC

 

[danskangel313]

Provider wants to bill Mcare for the following CPT code, but Labcorp says the DX code won't work. Here is the CPT code and Dx code he wants to use:

81241--Factor V Leiden---DX code D68.51

I looked up the LCD and this policy was revised 4/16 with No specific DX, and is says Non-Billable/Payable. If anyone has billed Mcare, was it paid or billed to the pt, we have been told this test cost about $300.

Thanks
Rosemary Hoormann,CPC

This genetic test is considered investigational so that's likely the problem. If the test is not covered under any circumstance because of this, there would be no DX codes that will ever make it payable. My local MAC has an LCD that clearly states "This testing is considered investigational and is NOT a Medicare benefit." There additional information pertaining only to pregnant women with very specific circumstances which might allow payment, but it doesn't go into any detail. If your local MAC states it's statutorily excluded, you would bill the patient. SuperCoder says the National Limit is $83.24.