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Wiki Bcbsnc, 99000 & 36415

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adaniel

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For the last few years we have been billing BCBSNC 99000 lab handling fee & 36415 venipuncture. BCBS would pay 99000 but deny 36415. In the last few months, both codes have been getting denied. I just found out that BCBS changed their Corporate Reimbursement Policy to say that 36415, 36416 & 99000 are all codes that are now considered inclusive to the primary procedure & not reimbursed separately....so basically we get reimbursed $0 for a blood draw!! Is anyone else having this problem?
 
You can always send the patients to an outside lab or have them come in on a different day. I'm actually surprised they have been paying it. The carrier I work for has been bundling routine venipuncture into the E&M or CLIA waived test for years and we have never covered 99000. I guess BCBS is trying to play catch up
 
Our office has always billed 36415-90 to our BCBSAL carrier and get reimbursed around $3.00. 36416 always denies as bundled. Never had any luck with 99000 either. Actually have had BCBS pend claims for additional information when we billed the 99000.

Hope this helps!
 
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