Wiki NC Medicaid DNA reimbursements?


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Good Morning. This is my first time posting so I hope I am doing this correctly.

I work at a lab and we have received 2 very large payments from NC Medicaid where Medicare has denied the DNA claim and it was sent on to the secondary, NC Medicaid. I've looked at NC Medicaid's fee schedule and seeing where they will reimburse on two codes 81240 and 81241, but they are paying full price on 81225,81226,81227,81291,81400 and 81355. Has anyone seen anything like this, or can shed some light on a better way to see if this is accurate, before having to make a phone call?

Thank you very much,
NC Medicaid DNA Reimbursements

Hi Allison,

I work for a genetic testing lab and we currently bill 81225, 81226, 81227 for PGX testing. We have not been able to get NC Medicaid to pay these codes, initially billed with a 59 modifier on the 81226, 81227 as we do with other payers and it was denied. We then billed them without modifiers and still denied...did you use modifiers and if so which one did you use to get these codes paid?

Thank you for any insight on this issue!