Wiki Cpt 87070 denied because of CLIA!

[Roscomare89]

Cpt 87070 keeps on getting denied and its due to our CLIA clearance, we have a level 2 and need a level 1 or 9 to bill this CPT code. Does anyone know of any other CPT we can bill that is close to CPT 87070 description?

 

[thomas7331]

You cannot bill another code that is 'close'. You can only bill for the service that was performed.

Your facility should not be performing tests for which it does not have the proper certification and it may be breaking the law by doing so. CLIA certification is not something that is done for purposes of billing and getting paid - it is a federal law and regulatory requirement to ensure the quality of lab testing. By performing tests without certification, your practice risks incurring penalties and sanctions. Billing for a different service to get paid would be compounding the problem, not solving it, by potentially breaking another law of submitting a false claim. Stop performing the test until this is corrected, and write off the denied charges and learn from the mistake so that it is not repeated in the future.