Point-of-Care Testing Reimbursement FAQs
What is the CPT® code for Prothrombin Time (PT) testing using a CoaguChek® professional system?
The correct CPT code is 85610. When performed as a CLIA-waived test, the “QW” modifier must also be included on Medicare and Medicaid claims.
What is the Medicare payment amount for CPT code 85610?
The 2007 Medicare Part B payment amount in most states for 85610/85610QW is $5.49. The 2007 Part B payment amount for 85610/85610QW is $4.89 in Iowa, $5.25 in Maryland, and $4.44 in Wyoming.
Can I bill CPT code 99211 to Medicare for ancillary staff services provided as part of “PT Clinic” services?
Significantly, separate evaluation and management (E&M) services that are provided by ancillary staff “incident to” a physician may be billable to Medicare and other payers when medically necessary. As with all services, the encounter must be documented in the patient’s medical record according to American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines. However, it is not appropriate to bill CPT code 99211 simply because a patient is seen in the office as part of a PT Clinic or other anticoagulation management service.
Do the new anticoagulation management codes 99363-99364 replace 99211?
CPT codes 99363-99364
are not separately billable to Medicare. Private and Medicaid coverage and payment policies for these new codes will vary. Please contact the individual plan or program for guidance regarding their individual policies on the use of these codes.
What are the billing codes for the ACCU-CHEK® Instant Plus system?
Blood glucose testing performed on an ACCU-CHEK Instant Plus system is reported under CPT code 82962. Cholesterol testing performed on this system is reported under CPT code 82465. The QW modifier is required only for the cholesterol portion of the test (e.g., QW is not added to 82962).
What is the CPT code for Chemstrip® Micral® test strips?
The Medicare CPT code for testing for microalbuminuria using Chemstrip Micral strips is 83518. The QW modifier is also required. Private payers and Medicaid programs may follow Medicare guidelines. However, some plans/programs may want this test reported under a different code—82044. Check with the specific plan or program for specific guidance.
Can I bill for the fingerstick or venipuncture for collecting the prothrombin time blood sample?
Medicare does not recognize or pay separately for capillary (e.g., finger, heel) blood specimen collection (CPT code 36416). Private plans and Medicaid programs may, so you should check with the individual plan or program for guidance. Medicare and most other payers cover and reimburse medically necessary collection of blood by venipuncture (CPT code 36415).
What is the CPT code for performing a blood glucose test using an ACCU-CHEK® Inform system?
CPT code 82962 is the only CPT code under which to report blood glucose monitoring using the ACCU-CHEK Inform system or any other ACCU-CHEK blood glucose monitor.
