Medical Billing Forum
Payments => Insurance Payments => : sjones@aimabms November 06, 2020, 08:54:00 PM
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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
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We have not billed it, and I'm not seeing reimbursement amounts posted. :(
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no luck with price yet. will post as soon as I have the info
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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
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Wow, the reimbursement by BC and BS is very low!
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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.
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That would be interesting to know. Also I was thinking maybe there is a patient responsibility on the lower payments?
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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.