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Wiki NC Medicaid Genetic Testing (PGX) Billing and Coding

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jbartunek1

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Hello -

I work for a genetic testing lab and we currently bill 81225, 81226, 81227 for PGX testing. We have not been able to get NC Medicaid to pay these codes, initially billed with a 59 modifier on the 81226, 81227 as we do with other payers and it was denied. We then billed them without modifiers and still denied...did you use modifiers and if so which one did you use to get these codes paid?

Thank you for any insight on this issue!
Jennifer
 
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