Wiki 99000/36415

[robinkea]

Is anyone being paid for 99000 for send out labs or 36415 for blood work done in the office? None of the carriers we bill are paying for either and I'm just wondering what the rest of you are experiencing.
Thanks in advance.

 

[Lucymedbilling]

36415 and 99000

Hi,
Yes, we are getting paid for 36415 from all ins. Are you using referring Dr. on your claim? box 17 on the form?

 

[robinkea]

Yes we are putting the referring physician but the ins companies are denying as incidential.
An example of what we bill would be: 99213-25, 80048 & 36415.

 

[crystalW712]

Yes we are paid for the 36415 but the 99000 is not covered by most carriers. Once in a while BC/Bs will pick it up but hasnt in a while

 

[dlpirtle]

We are getting paid from most insurance companies for the office visit and blood draw fee on the same date, but there are some companies that follow the McKesson software which shows that 36415 has a 90 day global on it. The CPT does not show any FUD's (global days) for this code. Any ideas on getting both codes paid, or should we just bill the laboratory codes we do and the office visit charge?

 

[jfree104]

how does McKesson software figure a venipuncture (36415) has a 90 day global? I'd say there is a glitch in the software.

 

[erjones147]

FWIW, we have never been paid for a 99000, and 36415 seems to vary (for us) depending on the carrier. Have not yet determined a pattern for acceptance or denial (i.e., certain labs allow it to go thru vs. other labs, etc.)