Wiki CPT Code 86580 PPD Testing - Medicare coverage

[MMelton845]

Hello,
Working with geriatric patients, many SNFs require PPD negative test before a patient can be admitted to their facility, even if they are showing no sign/symptoms or any exposure. Any recommendations for ICD-10-CM code to be covered by Medicare? Code Z11.1, encounter for screening for respiratory tuberculosis continues to be denied by Medicare. Any insight or help would be appreciated. Thank you !

 

[CBLENNIE]

A TB PPD test is not a covered preventive service which is are exempt from Medicare's exclusion per CMS IOM 100-02 Medicare Benefit Policy Manual Chapter 16 - General Exclusions From Coverage Section 90-Routine Services and Appliances. There is a list of specific services which are not excluded from Medicare coverage under Section 90.

Additionally, there is the following statement which both "a" & "b" applies to the PPD being required for admission to the SNF. There is no treatment of a specific medical condition and the SNF is a third party (they would be considered a business establishment) requiring the routine screening service.


A PPD test is only covered by Medicare if it is medically necessary and there doesn't appear to be any medical necessity for this service, it is an administrative requirement of the facility. While it may be a valid requirement, that doesn't mean Medicare is going to cover it. As we all know there are many services that Medicare does not cover, which we think Medicare should cover and that is just the way the program works as things stand.