Wiki How to bill PPD test to Medicare?

[lmolina]

I'm getting denials from Medicare for PPD test CPT 86580 with ICD10 Z11.1. The denial is PR49: This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Also, Medicare is denying the reading with 99211 and ICD Z11.11 for the same reason, PR49. Please, advise. Thanks in advance.

 

[thomas7331]

I'm getting denials from Medicare for PPD test CPT 86580 with ICD10 Z11.1. The denial is PR49: This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Also, Medicare is denying the reading with 99211 and ICD Z11.11 for the same reason, PR49. Please, advise. Thanks in advance.

Tuberculosis screening is not one of the preventive benefits that Medicare covers. If your Z11.1 diagnosis is correct, then the denials are correct and the services should be the patient's responsibility (unless their secondary insurance happens to cover it).

Here is a link that lists all of the preventive services that are covered by Medicare: Medicare Preventive Services

 

[lgardner]

Thomas is correct.

But, I have found that some providers (not sure that it would matter for Medicare) want a "reason" code after the primary Z11.1:
Z02.0 - Encounter for examination for admission to educational institution
Z02.1 - Encounter for pre-employment examination
Z02.2 - Encounter for examination for admission to residential institution

there are other codes in the Z02.* category that may apply.