Question 36415 billable with Labs?

ELBrock

Networker
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59
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I wondered if someone out there can help me find the guidelines that state the collection of the blood sample (36415) is not separately billable from the labs if they are performed in-house?
We frequently have a payer deny 36415 as not separately reimbursable from the lab charges, but other insurances have been known to pay for it. Is this insurance-specific, or is there a national guideline?
Thank you!
 

trarut

True Blue
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543
Location
Columbus, OH
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Generally speaking, 36415 is a separately billable service when billed with the related lab services. However, the payers can and do create their own policies regarding reimbursement so this is very insurance specific. I recommend looking for bundling edits or a reimbursement policy for each payer that will help you understand how they process those claims. When we had an in-house lab that we billed for, we billed 36415 when it was performed but had a standing adjustment authorization for the payers who had bundling policies and would not pay it separately. This allowed the payment posters to post the appropriate adjustments and keep the denied charges out of the A/R team workflow.
 
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