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Thread: 86580

  1. #1
    Join Date
    Apr 2007
    Houston, Texas

    Question 86580

    AAPC: Back to School
    I rec'd a denial from Medicare on 86580 stating "these are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam". Thing is, there was no office visit reported that day. Just the TB Test, by itself. (There was an office visit reported a few days prior to TB Test.) Patient came back a few days later to have it read and that was free of chrg. I'm not sure what to do here. Medicare wants me to put it into Patient Responsibility. I don't know if I need to rebill it out with a modifier or not... HELP!?

    Sarah, CPC

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    Per the CMS laboratory manual (including all lab NCD's), "Tests for screening purposes that are performed i the absence of signs, symptoms, complaints or personal history of disease or injury are not covered except as explicitly authorized by statute. These include exams required by insurance companies, busines establishments, government agencies, or other third parties." If this was a routine, screening TB test, it is not covered by Medicare. What diagnosis did the patient have for this test?
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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