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Wiki Genetic Testing?

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COMPauditor

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Has anyone billed for genetic testing to Medicare? My Pain Management group is providing patients with genetic testing, the CPT codes are 81225, 81226, 81227 and 81479. Medicare is only paying 81225 and denying the rest as not medically necessary.

Does anyone have any feedback on Genetic Testing? Any help is greatly appreciated...
 
I am familiar with genetic testing. You indicate that the Medicare carrier denied certain codes that you billed. I believe you would need do appeal with explanation letter of the services provided. And if they if decided to deny it after reviewing the additional documentation, they will write you a letter based on their reason and it will provide you a better understanding on their stance of the services that they are currently denying.
 
Where are you located? You may want to check with your MAC for an LCD. Some genetic tests are not covered because the literature does not support improved outcomes in Medicare beneficiaries. You would need to get ABNs for those tests.
 
We are located in Florida and I am trying to make sense of these LCDs but like dwaldman, I am not familiar with genetic testing either. We did appeal the denials with a rather informative appeal letter created by our Chief Medical Officer that offered Medicare with references and articles of why the need for the testing but still Medicare denied all but 81225.
 
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