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Wiki 81513, 87481, 87661 denied and requested to be replaced with 87801

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Cheri L

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Albuquerque, New Mexico
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I work for an independent lab and we are experiencing different payer payment methods when billing 81513, 87481, 87661 with and without 87494. Aetna, UHC, Cigna, and Presbyterian Health Plan (New Mexico) are denying and or converting 81513, 87481, and 87661 to 87801. We currently do not bill for 87801. If testing methodology is met for 87801, would 87801 x3 be billed? Do insurances have the right to down-code not knowing the lab's testing methodology? Thank you.
 
Can you submit an appeal with documentation showing that the test does not meet 87801 testing method? I know is some instances insurance will recognize that you charged the individual components of panel, therefore will pay you the panel CPT code and not for each individual code. Do you have any contract managers at your facility that can review with you? Best of luck!
 
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