Wiki 36415 venipuncture code bcbsil

Create Wiki
A

asrakhan24

New
Messages
3
Location
Naperville, IL
Best answers
0
So we bill 36415 with modifier 59 to bcbs and it always gets paid. But now its being rejected as incidental to other labs. PEr bcbs agent, new guidelines since may 2017. Any idea how I can get the 36415 to get paid? Is anyone going thru the same problem. I work for two providers and both of them have the same issue.
 
While NCCI edits do not bundle 36415 into most laboratory codes, it appears that BCBS, corporately, bundles 36415 into all laboratory codes as part of their edits. Having said that, I don't see anything in BCBS of IL recent edits update that states they are no longer recognized modifier 59 with these codes: View attachment cxt_rule_descriptions.pdf

However, BCBS of NC has a corporate policy that states CPT 36415 is bundled into laboratory services and is not eligible for separate reimbursement: View attachment code_bundling_rules_not_addressed_in_claim_check.pdf.

I could not locate the same policy for BCBS of IL, but I am pretty sure they have a similar policy. I would contact my BCBS of IL provider representative and ask them for a copy of the policy. You can also get your providers involved and file an appeal with BCBS of IL's medical director to petition a change in the policy - especially since Medicare currently does not bundle these procedures.

Hope that helps!
 
36415 venipuncture

Thank you . yes I found the same reasons for the 36415 not being paid. OUr district provider rep has no clue and apprently she is still figuring it out:(
 
You must log in or register to reply here.
Top