Wiki How do I find out what payers reimburse a test?

[hemligduva]

Hi all, I would like to know what payers reimburse the test PLA/CPT 0342U, IMMRAY PanCan-d.
Does anyone know where I could find that information? I don't have the budget to use find-a-code. There must be some other way?

Best regards,
Mart

 

[sls314]

Hi all, I would like to know what payers reimburse the test PLA/CPT 0342U, IMMRAY PanCan-d.
Does anyone know where I could find that information? I don't have the budget to use find-a-code. There must be some other way?

Best regards,
Mart

For commercial payers, you'd need to check the provider's contract for each specific insurance company.

For Medicare, you would check the clinical lab fee schedule: https://www.cms.gov/Medicare/Medica...eSched/Clinical-Laboratory-Fee-Schedule-Files

For Medicaid, you'd need to look up the specific state's Medicaid fee schedule. (Medicaid is state-specific. If you need the rate for more than one state, you'd have to look it up for each state.)

 

[hemligduva]

Thank you for your reply. So you suggest I ask the provider about what insurance companies they have a contract with?