Results 1 to 3 of 3

Thread: Medicare denied CPT 81000

  1. #1

    Question Medicare denied CPT 81000

    Hi All,

    Medicare has denied CPT 81000 stating "This provider was not certified/eligible to be paid for this procedure/service on this DOS."

    DidDo we need to add any modifier to 81000?? E.g QW modifier

    Please help..

    Neha Bhatnagar CPC, CPC-H

    "Believe you can and you're half way there."

  2. #2


    I'm getting the same denial. I don't think QW will change anything as the 81000 is not clia waived. We have a type 4 certification and I can't seem to figure out why one dr in our office gets paid for this code and the other doesn't.... please let me know if you find out anything. Thanks

  3. #3
    Join Date
    Apr 2007
    Fayetteville, North Carolina


    Do your providers have PPMP certificates - Provider Performed Microscopy Procedures certificate? There are only a few tests that need this certificate to qualify, but 81000 is one of them.

    Stefanie Cramer, CPC
    Sr. Coding Specialist
    Cape Fear Valley Health Systems

Similar Threads

  1. CPT 37197 Denied by Medicare as not billable in office
    By menglish19 in forum General Surgery
    Replies: 0
    Last Post: 06-11-2015, 11:26 AM
  2. Medicare Denied CPT code 92588
    By in forum ENT/Otolaryngology
    Replies: 3
    Last Post: 03-09-2015, 05:56 PM
  3. 86580 Denied by Medicare
    By lpack in forum Diagnosis Coding
    Replies: 2
    Last Post: 05-12-2014, 01:44 PM
  4. Medicare denied colonoscopy
    By tholcomb in forum Gastroenterology
    Replies: 1
    Last Post: 09-06-2013, 12:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts