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Medicare denied CPT 81000

  1. Question Medicare denied CPT 81000
    Exam Training Packages
    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. Default
    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
    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
    Independent Contractor
    Medical Coding and Consulting
    Cramer Consulting

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