Wiki Medicare denied CPT 81000

[neha.bhatnagar]

Hi All,

Medicare has denied CPT 81000 stating "This provider was not certified/eligible to be paid for this procedure/service on this DOS."

DidDo we need to add any modifier to 81000?? E.g QW modifier

Please help..

Thanks..

 

[bill2doc]

I'm getting the same denial. I don't think QW will change anything as the 81000 is not clia waived. We have a type 4 certification and I can't seem to figure out why one dr in our office gets paid for this code and the other doesn't.... please let me know if you find out anything. Thanks

 

[Stefanie]

Do your providers have PPMP certificates - Provider Performed Microscopy Procedures certificate? There are only a few tests that need this certificate to qualify, but 81000 is one of them.