Laboratory Question for the Week of October 9, 2017

Laboratory Compliance Question of the Week

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.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.