Medical Billing Forum

Payments => Insurance Payments => Topic started by: sjones@aimabms on November 06, 2020, 08:54:00 PM

Title: Payment for 87426 antigen test
Post by: sjones@aimabms on November 06, 2020, 08:54:00 PM
Has anyone billed 87426 Infectious agent antigen detection by enzyme immunoassay technique, what is the reimbursement from Novitas or any other MAcs.  CLFS does not seem to have the price listed and has left for the MACs to price
Title: Re: Payment for 87426 antigen test
Post by: Michele on November 09, 2020, 11:20:45 AM
We have not billed it, and I'm not seeing reimbursement amounts posted.   :(
Title: Re: Payment for 87426 antigen test
Post by: sjones@aimabms on November 25, 2020, 05:55:48 PM
no luck with price yet.  will post as soon as I have the info
Title: Re: Payment for 87426 antigen test
Post by: RichardP on December 09, 2020, 08:49:23 PM
Re. payment for CPT 87426:

This is for Los Angeles, CA.  Just did a quick search to get some ballpark figures / ranges.  This is from Office Ally, which does not have good search capabilities.

Noridian / Medicare:  $35.33

United Healthcare:  30.00

Blue Cross of California:  $11.98

Blue Shield of California:  $5.75

Title: Re: Payment for 87426 antigen test
Post by: Michele on December 10, 2020, 10:11:29 AM
Wow, the reimbursement by BC and BS is very low!
Title: Re: Payment for 87426 antigen test
Post by: RichardP on December 10, 2020, 03:59:36 PM
Yes.

I just wanted to show the range of what we have received.  What I don't know, because the search feature is poor in Office Ally, is whether there is variation in payment within a Carrier (e.g., Blue Cross of California) based on the plan that a patient has.
Title: Re: Payment for 87426 antigen test
Post by: Michele on December 10, 2020, 04:22:22 PM
That would be interesting to know.  Also I was thinking maybe there is a patient responsibility on the lower payments?
Title: Re: Payment for 87426 antigen test
Post by: RichardP on December 10, 2020, 04:36:01 PM
A quick check on a few shows no patient responsibility.

I'm not going to take the time to check now, but I do believe that patients are not to be charged anything for work that is related to C19.  Even if they have no insurance, I think Medicare published options for the provider to get some sort of reimbursement that does not involve charging the patient.

With the vaccine(s) on the horizon, with some rather nasty side effects reported that will require medical attention, it is going to be interesting to see whether the "don't charge the patient" edicts will apply to that arena as well - since it can be argued that side effects needing treatment are still related to C19.