Moda/ods

CodingKing

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Its been more than a decade since I worked for ODS but looking at their payment policies I found


For 81003
https://www.modahealth.com/pdfs/reimburse/RPM016.pdf

Specimen validity testing is not eligible to be separately billed under any procedure codes (e.g. 81000, 81001, 81002, 81003, 81005, 81099, 82570, 83986, or any other code). This is because for all codes in range G0477 – G0483, the code description indicates that this testing is included if it was performed.

For 36416 (the answer is never)

https://www.modahealth.com/pdfs/routine_venipuncture.pdf

CPT 36416 is designated as a status B code (bundled and never separately reimbursed) on the Physician Fee Schedule RBRVU file. ODS clinical edits will deny CPT code 36416 with explanation code WGO (Service/supply is considered incidental and no separate payment can be made. Payment is always bundled into a related service), whether 36416 is billed with another code or as the sole service for that date. This edit is not eligible for a modifier bypass.
 
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