What does CPT code 81401 mean?

04/26/2020 Off By admin

What does CPT code 81401 mean?

Molecular Pathology Procedure
Providers use Tier 1 CPT codes to bill for common genetic tests. For example, more than 50 different specific genetic tests belong under CPT code 81401 (Molecular Pathology Procedure, Level 2).

Is CPT covered by Medicare?

Certain services are never considered for payment by Medicare. These include preventive examinations represented by CPT codes 99381-99397. These modifiers are not required by Medicare, but do allow for clean claims processing and billing to the patient. …

Is genomic testing covered by Medicare?

Medicare has limited coverage of genetic testing for an inherited genetic mutation. Medicare covers genetic testing for people with a cancer diagnosis who meet certain criteria; you must have a cancer diagnosis to qualify for coverage of genetic testing for an inherited mutation under Medicare.

Does Medicare cover molecular pathology?

Many applications of the molecular pathology procedures are not covered services by Medicare given lack of benefit category (preventive service) and/or failure to reach the reasonable and necessary threshold for coverage (based on quality of clinical evidence and strength of recommendation).

What is procedure code 81479?

Use 81479 to report a molecular pathology procedure that does not have a specific code.

Is CPT 93000 covered by Medicare?

Medicare will deny the 93000 when billed in conjunction with the Medicare Wellness Visits and screening dx. CMS website actually has a whole 300 page manual devoted to their wellness program. You can search “preventative services” and it should lead you right to it.

Is CPT 75571 covered by Medicare?

Quantitative calcium scoring (CPT 75571) is not a covered service and will be denied as not medically necessary. Calcium scoring reported in isolation is considered a screening service.