Payment on claim

sab001

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How to get paid on procedure code 81479....and procedure code 81401 two units
81401 is a Tier 2 MoPath code and 81479 is an unlisted MoPath code.

81401 - The specific gene must be listed in the Tier 2 code. In addition the associated procedure must be listed as well. For example, you can use 81401 if you are testing for common variants of APOB; however, you cannot use the code if you are performing deletion/duplication of APOB.

Receiving reimbursement is up to the payor. It would be best to review reach out to them and ask for specific instructions. Please note, some payors do have procedures in place. For example, BCBS-TX recently created a form that can be used when billing for Tier 2 codes.

Expect the payor to push back and ask for additional information and/or deny the claim altogether. If they do, follow the appeal process and provide detailed information about what codes you are billing for.
 

sab001

Networker
Messages
40
Location
Pasadena/LaPorte Texas Chapter
Best answers
0
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