Wiki Payment on claim

[teedybell]

How to get paid on procedure code 81479....and procedure code 81401 two units

 

[sab001]

How to get paid on procedure code 81479....and procedure code 81401 two units

81401 is a Tier 2 MoPath code and 81479 is an unlisted MoPath code.

81401 - The specific gene must be listed in the Tier 2 code. In addition the associated procedure must be listed as well. For example, you can use 81401 if you are testing for common variants of APOB; however, you cannot use the code if you are performing deletion/duplication of APOB.

Receiving reimbursement is up to the payor. It would be best to review reach out to them and ask for specific instructions. Please note, some payors do have procedures in place. For example, BCBS-TX recently created a form that can be used when billing for Tier 2 codes.

Expect the payor to push back and ask for additional information and/or deny the claim altogether. If they do, follow the appeal process and provide detailed information about what codes you are billing for.

 

[sab001]

Here is the link to the information provided by BCBS-TX. I expect other insurance payers to do the same or something similar.

http://www.bcbstx.com/provider/pdf/genetic_testing_form_instructions.pdf

The form is located at http://www.bcbstx.com/provider/pdf/genetic_testing_form.pdf
I noticed that not only is this form specific to the Tier 2 codes. They also provide a page for the unlisted 81479 as well. This form is for BCBS-TX. Other BCBS plans might have their own.