Medicare Ordering/Referring Provider - Pathology - Oral

davehudgb

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Des Moines, IA
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Good Afternoon -

We are presently having some issues with providers that are ordering pathology examinations on oral tissues biopsies. The providers have completed information on PECOS Online or Paper Application. We are seeing denials from Medicare on a few of our providers. The providers are listed on the data.cms.gov as being eligible to order testing. The issue at hand is once the claim is received and processed by Medicare, they deny our claim. We on rare occasion has been told it's the specialty type that the ordering provider has selected. The can not order such a test.

So what I'm trying to determine is can a provider, who has selected Dentist as a specialty - order a biopsy of the mouth or oral region? Is there a published list of what testing each specialty can order?
 
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