Oklahoma

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Cell-Free Fetal DNA Testing aka Non-Invasive Prenatal Testing (NIPD)

Mon, 2013-04-22 09:38

This message is regarding services for cell-free fetal DNA testing billed to members served by the Oklahoma Health Care Authority (OHCA). These tests may be marketed under trade names including MaterniT21 (Sequenom),Harmony (LabCorp/Ariosa), Panorama (Bio-Reference Labs/Quest/Natera), or Verifi (Verinata).  The list prices for these tests range from ~$800 to ~$2,700.

Billing for Molecular Pathology Codes

Thu, 2013-02-28 11:07

This message clarifies billing requirements for claims involving molecular pathology CPT codes in the 81200-81479 range.  Because these codes are manually priced, providers will need to submit an attachment (itemized invoice of services performed) with any claims that include molecular pathology procedures. Claims involving molecular pathology procedure codes in the 81200-81479 range that are submitted without an attachment will be automatically denied.

Infectious Agent Detection by Nucleic Acid

Thu, 2013-02-28 11:09

When using nucleic acid amplification techniques to test for a single infectious organism that lacks a specific CPT code in the 87470-87660 range, billing a single unit of CPT code 87798 is appropriate.  When nucleic acid amplification techniques are used to test for more than one infectious organism in a specimen, whether or not a specific CPT code in the 87470-87660 range is available (such as in an infectious disease panel), billing a single unit of CPT code 87801 is appropriate. OHCA has determined that billing multiple units of CPT code 87798 rather than a single unit of 87801 has led

MUE Edited Codes Billed Over the Allowed Limit

Thu, 2011-07-28 17:00

Procedures and services that are subject to Medically Unlikely Edits (MUE) may be allowed to exceed those limits if medical necessity is established for the additional units. Documentation must be appended with the claim to support the additional services and the additional units must be billed on separate lines with the appropriate modifiers listed to show it is a repeated service.

MUE Edited Codes Billed Over the Allowed Limit

Thu, 2011-07-28 17:00

Procedures and services that are subject to Medically Unlikely Edits (MUE) may be allowed to exceed those limits if medical necessity is established for the additional units. Documentation must be appended with the claim to support the additional services and the additional units must be billed on separate lines with the appropriate modifiers listed to show it is a repeated service.

Orders for Diagnostic Testing

Wed, 2009-12-02 10:33

TrailBlazer Health Enterprises® - Carrier/FI for Colorado, New Mexico, Oklahoma, Texas and Virginia.

Due to the recent increase in the number of errors identified during the Comprehensive Error Rate Testing (CERT) contractor audit for the lack of physician orders for diagnostic tests, TrailBlazer recommends that providers sign all orders for testing and/or progress notes showing the intent for testing to be completed.

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