Wiki 87502, 87634 and 87635

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amcsherry

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Are we no longer allowed to bill out 87502, 87634 and 87635? We've never had any issues with the insurance companies paying but over the last 2 weeks the insurance companies have been declining to pay the codes we billed and instead they've been adding cpt code 87631 and paying that.
 
We are seeing this as well. Our lab equipment doesn't perform a panel for these three tests. We use individual swabs, and run all labs individually. In the past, I've been able to fight these denials with the CMS LCD Article #A58741 showing that the definition of a panel test is for a SINGLE specimen. I couple that with the manufacturer coding guidance for our lab, as well as CPT Guidelines stating we should be using "the most specific code possible". (In other words, using a generic code is not specific when there are individual ones that ARE, show the exact test we performed, do not align with the definition of a panel according to CMS) and I've won. I'd love to hear how others are dealing with this because I am SICK and tired of laying down and letting these payers WHO CAN AFFORD TO PAY US, discount our reimbursement.
 
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