Wiki Routine labs showing provider responsibility by Cahaba MAC

[reneemiller]

Good Day Group:

Recently our MAC Cahaba has denied routine labs like A1c 83036 when billed with the Z00.00 diagnosis. This is not unusual but the EOB used to assign these charges to the patient liability. Now our EOBs are showing provider liability. We are appealing these attaching Medicare's own standard policy that routine labs are the patient liability but has anyone heard anything about why this might be happening and any work around? - I found no help on the Cahaba site.

Thank you for your feedback and have a great day!!

Renee/Tennessee

 

[CodingKing]

If the lab would have been covered if the patient had a covered diagnosis wouldn't you need an ABN? Its not like a routine physical itself where the code is never covered.

 

[reneemiller]

Hi, you might think so but in the past no ABN or modifier reporting signature on an ABN was required. Cahaba processed labs billed with a routine diagnosis to the patient responsibility. And, we have a CMS document showing this is correct. Cahaba has just recently, for no explanation, reported these back as provider responsibility so we're appealing them all. Will continue to do so - thanks and have a great weekend!