Wiki QHIV-86703

[yulondameridy@gmail.com]

Hello...

Can anyone tell me how they've sucessfully billed, and received payment for, the QHIV CPT code 86703 for a commercial payer? I've tried several different modifiers (92, 33) with no luck.

Thanks,

 

[antoniamay]

What are the DX codes you are using and what is the denial reason you are getting?

 

[yulondameridy@gmail.com]

Z11.3 (primary), Z71.7, and Z11.4

 

[CBLENNIE]

What is the denial reason on the remit?

 

[yulondameridy@gmail.com]

Primarily from Anthem, stating that the lab wasn’t in the preferred network

 

[antoniamay]

That sounds like a benefit denial then, the member may not have coverage to out of network labs.

 

[antoniamay]

Primarily from Anthem, stating that the lab wasn’t in the preferred network

I would contact whoever at your lab is in charge of contracting to see if you can get contracted, then if you get contracted, you can appeal all the claims. Also make sure they are getting your patients to sign financial responsibility forms if you don't so you can bill them when their insurance denies it for no coverage.