Question:
If a Medicare claim for a lab test is denied due to one of the CCI edits, can it be billed to the beneficiary?
Answer:
In the introduction for the National Correct Coding Initiative Policy Manual for Medicare Services, the Centers for Medicare & Medicaid Services (CMS) state that a service denied based on procedure-to-procedure code pair edits or medically unlikely edits (MUEs) may not be billed to Medicare beneficiaries. It also states that provider cannot use an Advance Beneficiary Notice of Noncoverage (ABN) to seek payment from Medicare beneficiaries.
This question was answered in the September edition of our Laboratory Compliance Manager. For more hot topics relating to laboratory services, please view our store, or call us at 1.800.252.1578 ext. 2.
CPT® copyright 2024 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
Unlock 50% off all 2024 edition books when you order by July 5! Use the coupon code CO5024 at checkout to claim this offer!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24Â