Urology Coding Alert

Question: Can we expect reimbursement for CPT 86294 ?Answer: Use 86294 (Immunoassay for tumor antigen, qualitative or semiquantitative [e.g., bladder tumor antigen]) for the bladder tumor antigen (BTA) or nuclear matrix protein (NMP)-22 testing kits, and you should be paid.Caveat: Remember this is a Clinical Laboratory Improvement Amendments (CLIA) waived study, and you must add modifier QW (CLIA waived test). Medicare reimbursement will vary by state from $11.93 to $27.61. If your practice has CLIA-waived status, you can perform (and bill for) these tests. For your practice to perform CLIA-waived testing, Medicare requires that you:Enroll in the CLIA program by obtaining a certificate and pay the certificate fee every two years. Follow the manufacturers' instructions for the waived tests.Notify your state agency of any changes in ownership, name, address, or director within 30 days, or if you wish to add tests that are more complex; and allow inspections by a [...]