Wiki Polymerase Chain Reaction for UTI billing

[MaryLouD]

My office is wanting to bill for polymerase chain reaction for UTI's. We upgraded our CLIA to a high complexity lab in order to do this. However, the I am not sure the codes we were provided are all eligible for billing. The codes we were told were billable are: 87481 x 2 units with 59 modifier, 87500, 87640-59, 87641-59, 87653-59, 87998 x 13 units - 59 modifier, 87801 x 3 units. Is anyone familiar with this? Any help would be appreciated.

 

[bevsimpson]

My urology office has been billing PCRs for almost a year with the following codes: 87640,59 1 unit; 87641,59 1 unit, 87798,59 16 units (13 units for Medicare and some other payers) 87500, 1 unit and 87801 3 units. We are finding that ALL Medicare and replacements deny 87641. We are also finding some payers, mostly BCBS and UCD requiring additional medical records to provide medical necessity for 87798 - once records are sent, this code is still consistently denied. I am looking for help with this as well.