coderbiller99
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Hi everyone,
Our practice runs respiratory pathogen panels and we’ve been billing multiple individual CPT codes for the organisms detected — for example:
• 87486 (Chlamydia pneumoniae)
• 87581 (Mycoplasma pneumoniae)
• 87594 (Pneumocystis jirovecii)
• 87641, 87635, 87651, 87798, etc.
We submitted these codes to Devoted Health (Medicare Advantage), and the claim was denied with the following message:
“Adjusted when billed as individual tests instead of as a panel.”
“Please attach the amplified probe technique documentation… and resubmit.”
We uploaded the full lab report showing the amplified probe technique and the pathogens tested, but Devoted still kicked it back.
I called Devoted, and their rep told me that we should be billing these as a panel . But here’s the catch:
CMS Article clearly states that a panel code like 87633 is not covered by Medicare — so we’ve been avoiding that code to stay compliant.
Now we’re stuck in a weird situation where:
• Devoted denies unbundled codes, but
• CMS doesn’t cover code like 87633, and
• We don’t want to get flagged for incorrect billing.
Has anyone here successfully billed Devoted Health for RPP tests? Did you use 87633? Were there any documentation tips or modifiers that helped?
Any advice is greatly appreciated — just trying to make sense of conflicting policies here.
Thanks in advance!
Our practice runs respiratory pathogen panels and we’ve been billing multiple individual CPT codes for the organisms detected — for example:
• 87486 (Chlamydia pneumoniae)
• 87581 (Mycoplasma pneumoniae)
• 87594 (Pneumocystis jirovecii)
• 87641, 87635, 87651, 87798, etc.
We submitted these codes to Devoted Health (Medicare Advantage), and the claim was denied with the following message:
“Adjusted when billed as individual tests instead of as a panel.”
“Please attach the amplified probe technique documentation… and resubmit.”
We uploaded the full lab report showing the amplified probe technique and the pathogens tested, but Devoted still kicked it back.
I called Devoted, and their rep told me that we should be billing these as a panel . But here’s the catch:
CMS Article clearly states that a panel code like 87633 is not covered by Medicare — so we’ve been avoiding that code to stay compliant.
Now we’re stuck in a weird situation where:
• Devoted denies unbundled codes, but
• CMS doesn’t cover code like 87633, and
• We don’t want to get flagged for incorrect billing.
Has anyone here successfully billed Devoted Health for RPP tests? Did you use 87633? Were there any documentation tips or modifiers that helped?
Any advice is greatly appreciated — just trying to make sense of conflicting policies here.
Thanks in advance!
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