Wiki Acceptable payments for CPT Codes

[chaanobong@gmail.com]

I need some billing advice and hope someone can help me. We run tests with CPT codes 85025, 85027, 85004, 85007, and 85008.



If lab billed the following combination of CPT codes would Medicare and/or commercial insurance reimburse for both codes?

1. 85027 and 85007
2. 85027 and 85008
3. 85025 and 85007
4. 85025 and 85008

 

[sls314]

I need some billing advice and hope someone can help me. We run tests with CPT codes 85025, 85027, 85004, 85007, and 85008.



If lab billed the following combination of CPT codes would Medicare and/or commercial insurance reimburse for both codes?

1. 85027 and 85007
2. 85027 and 85008
3. 85025 and 85007
4. 85025 and 85008

Only one of those code pairs can be billed together. There are NCCI edits for 3 of those code pairs. For those 3 pairs, the edits don't allow a modifier, so the codes cannot be billed together.

1. 85027 and 85007 - There is no NCCI edit for this code pair. Can be billed together when performed.
2. 85027 and 85008 - NCCI conflict, modifier is not allowed. Don't bill together.
3. 85025 and 85007 - NCCI conflict, modifier is not allowed. Don't bill together.
4. 85025 and 85008 - NCCI conflict, modifier is not allowed. Don't bill together.

 

[chaanobong@gmail.com]

Only one of those code pairs can be billed together. There are NCCI edits for 3 of those code pairs. For those 3 pairs, the edits don't allow a modifier, so the codes cannot be billed together.

1. 85027 and 85007 - There is no NCCI edit for this code pair. Can be billed together when performed.
2. 85027 and 85008 - NCCI conflict, modifier is not allowed. Don't bill together.
3. 85025 and 85007 - NCCI conflict, modifier is not allowed. Don't bill together.
4. 85025 and 85008 - NCCI conflict, modifier is not allowed. Don't bill together.

Thank you so much Susan.