Question CLIA/claim rejections

mgarcia400

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Can anyone advise on the type of CLIA certificate a family practice needs for rapid tests and in-house urine drug tests. I have been getting rejections on rapid strep test (cpt 87880) and drug urine tests ( cpt 80306), specifically from United Health Care. Stating CLIA does not meet certification level. These claims are rejecting at the clearinghouse and not even making it to the insurance.

Any input is greatly appreciated!
 

thranowski

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87880-QW is CLIA waived. We use that in my office. So I assume the issue is with 80306. What is the exact drug test you are using? Perhaps you're using the wrong CPT code.
 
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Our certificare says "Centers for Mediare and Medicaid Services
Clinical Laboratory Improvement Amendments"
Certificate of Waiver

Along with clia number and effective/expiration dates
Hi there, 80306 is not a CLIA-waived test. That's performed on a moderate-complexity device that provides instant results. I believe it is most commonly used in emergency rooms.

Are you using QW with the rapid strep test?
 

thranowski

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Hi there, 80306 is not a CLIA-waived test. That's performed on a moderate-complexity device that provides instant results. I believe it is most commonly used in emergency rooms.

Agree this is either the wrong CPT or the wrong test. Perhaps 80305-QW? There are a ton of CLIA waived urine drug tests approved under that CPT code, I'd check to see if the test OP is using is one of them.
 
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Agree this is either the wrong CPT or the wrong test. Perhaps 80305-QW? There are a ton of CLIA waived urine drug tests approved under that CPT code, I'd check to see if the test OP is using is one of them.
Right, it's impossible to say which code they should use without knowing how they are performing the test. 80306 could indicate they some sort of tabletop analyzer, but I've heard of people being confused by the descriptor and thinking they can report the code for simple dipstick/cup tests.
 
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