Wiki Medicare and screening codes

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Yathink67

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Some of the providers in my office are sending routine physical labs out with either Z00.00 or Z00.01 and Medicare is denying them.
I was under the impression that Medicare would not pay for any screening codes, at my previous employer, and the actual condition needed to be coded.
If this is not the case I would love to know what screening codes are actually covered by Medicare? Thanks for any insight!
 
This is a good tool that I use as a reference for all of the preventive and screening services that Medicare covers.
You can click on the individual items to get the detail about what the coverage requirements are for each one:

https://www.cms.gov/Medicare/Preven...ntive-services/MPS-QuickReferenceChart-1.html

As you will see, Medicare does cover some labs done for screening purposes, but Z00.00/Z00.01 would not be appropriate diagnosis codes for this. Most require a code from the Z13 series or other Z code to identify specifically what disease is being screened for.
 
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Basically I am looking for a few diagnosis codes that will be covered for physical blood work to be done prior to the patients appointment with the providers.
Or a few diagnosis's that the providers can remember to use so the labs will be covered by ANY insurance.
Right now I have it narrowed to Z13.1, Z13.22, Z13.220, Z13.6. IF IN FACT MEDICARE WILL PAY FOR THESE SCREENING CODES?
 
I don't think you'll find an easy solution as that - the CPT and ICD-10 codes have to be used in the correct combinations. In any case, Medicare's coverage of labs for preventive purposes is pretty limited. For screenings, they'll cover the glucose test with Z13.1, the lipid panel with Z13.6, the PSA test with Z12.1 and a few others in specific circumstances, but there isn't a blanket set of diagnosis codes that will get you coverage of all labs that many providers order on a routine basis for preventive purposes.
 
I did not think there would be, but was hopeful I could narrow it down to just a few they would have to remember!
Thank you for you time today!
 
I did not think there would be, but was hopeful I could narrow it down to just a few they would have to remember!
Thank you for you time today!
 
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