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I am trying to bill TB tests in emomed using Z1190 and procedure code 86580. Billing under pharmacy. It is not paying. Does anyone have any ideas on this? Am I using the wrong codes?
This is an issue we as Franklin County Health Department ran into, therefor we are no longer submitting to insurances for TBs.
We charge the patient $10 for the initial visit, and another $10 for the read. I understand this does not answer your question, it does give you another avenue to think about. 🙂I don’t recall that I have ever billed TB, but the codes you are using are correct, according to my notes. But why file under pharmacy? If you don’t have to provide an NDC number, I would file it as a medical claim. My best advice.
I was going to say the same thing, effective last fall sometime, Medicaid no longer pays for TB testing.
Christina
I billed one in Sept on a child and got paid…according to Fee schedule (Independent Lab Tech Component) fee for TB is 6.37 as of 1-1-18. I use Procedure code 86580 for PPD and 99211 EP for office visit of $16.78 with Dx code of z11.1 for both. Then I also bill the office visit to read with the 99211 EP – 86580.
I have not heard anything about Medicaid not paying for TB but haven’t had one to bill since Sept.
I bill the same as Carol but with no office (We have to “Touch the client twice to bill office) I get all of my TB’s paid with DX Z11.1 and CPT code 86580.
I’ve never billed TB to any insurance before. I was told it’s not covered ever. We charge $20.00m for the test, no charge for the read.
I found out the hard way too!! Claims being denied. I have been advised that Medicaid is not paying for TB test any longer. We were billing for $15.00 on the pharmacy claim and $5.00 for an office visit reading and getting denied for the pharmacy part. According to what I was told, claims for dates of service after Sept 1, 2017 TB tests are no longer being covered because they are a “non-rebate product”. Apparently, there is no longer a federal rebate for this item, therefore Medicaid has decided not to cover the test. This information is on Provider Bulletin dated Aug 10, 2017 under Non-Rebate Eligible Products.
We are now billing an office visit 99211 under ICD-10 code Z11.1 for $10.00 when the test is placed and another office visit 99211 under ICD-10 Z11.1 for $10.00 when they come back to get their reading.
I just billed a TB test to (straight Medicaid) MO HEALTH NET. I was paid $16.28 for the office visit and $6.00 for the TB test. I used CPT code 86580 and Diagnosis code Z11.1. for the TB test and 99211 for the OV.
I bill to all of them. I just posted this one because I just billed it and with straight Medicaid you are able to see if it pays or not and after reading other posts I thought I would share that I did plan on getting paid. I use the same CPT and Diagnosis codes with the other plans. In the past they have always paid. For sure they paid the OV. We really don’t do that many TB tests that are Medicaid but I have never had a problem getting paid.
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