Wiki Age limit to bill RSV test 87807?

[thranowski]

Is anyone aware if RSV 87807 has an age limit to bill? Right on the box it says not to test children 4+ so I don't know if that means insurance won't pay. We've never billed 4+ but just recently I had a test done on a 6 year old so just curious. I'm going to bill it anyway but I'd rather warn the providers not to do this if they won't pay.

Thanks.

 

[thomas7331]

I'm not aware of any specific restrictions on this, but payment is always a matter of payer policy - every insurance is different. You'd have to look at the specific plan and policy documents of the patient's insurance to whom you're billing to be able to answer this.

 

[brucep]

I'd add that administering a test that the manufacturer has stipulated for use by children under the age of 4 to a child over that age goes against the terms of the Certificate of CLIA Waiver that your lab is operating under. Per CMS, "it is not acceptable for you to make changes to the current instructions provided with the test system. This could change the 'intended use' of the test system as approved by FDA and result in a test that is no longer waived." This means "your laboratory is subject to an inspection and additional CLIA requirements," and the test results themselves could lead to "inaccurate results that may result in a misdiagnosis or delay in proper treatment of a patient." See https://www.cms.gov/Regulations-and...IA/downloads/HowObtainCertificateofWaiver.pdf

 

[thranowski]

I'd add that administering a test that the manufacturer has stipulated for use by children under the age of 4 to a child over that age goes against the terms of the Certificate of CLIA Waiver that your lab is operating under. Per CMS, "it is not acceptable for you to make changes to the current instructions provided with the test system. This could change the 'intended use' of the test system as approved by FDA and result in a test that is no longer waived." This means "your laboratory is subject to an inspection and additional CLIA requirements," and the test results themselves could lead to "inaccurate results that may result in a misdiagnosis or delay in proper treatment of a patient." See https://www.cms.gov/Regulations-and...IA/downloads/HowObtainCertificateofWaiver.pdf

Thank you so much! This is very helpful.