Wiki How frequent can a lab be billed annually for mcare reimbursment ?

[cynthiaarellano14@yahoo.com]

Just wondering if anyone knows if there is a mcare list to be found that would tell how many times an op lab could be run in a year and be reimbursed on, i have a provider that is wanting to know the allowed frequency on about 30 different op labs, i have looked all over the cms web site & just didnt have much luck, i appreciate any help on this that i can get

 

[Lajolla21]

there should be a fee schedule you can download and find your code listed w/ the price in your area/ frequency (phys fee sch, opps (out pt pros. payment syst) fee sch, etc...). the other thing you can try is calling 1-800-medicare, ask to be entered as a contact, then transferred to a tier II b/c you have a specific code you want to look up for coverage. tier I's can give you genral guidelines. hopefully those are not routine labs!

 

[Kris78]

Normally if I call Medicare to get info regarding certain labs or even frequency on them I will receive the same response, "Yes it is covered as long as the physician documents (submit) reason as to why he wants that lab done."

 

[edose09]

Also make sure to check out the lab NCD and LCD's. There are only certain codes that cover some of the lab test. Also make sure to get an ABN signed if they do not have covering DX.

There is also the General Health Panel that is never covered by Medicare and physicians should watch out for that and get the ABN on this one if they don't want angry patients.