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.

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