Medicare denying CPT® 82948

Hi,
I have a concern in this CPT® code used.
Medicare denies it, and they said that it is not included in the CLIA waived test.
Is there any appropriate code instead of using this code 82948.

Pls need some advice from you guys.

Thanks...

re: Medicare denying CPT® 82948

This code is on the Medicare fee schedule but it is not CLIA waived. Maybe it's your diagnosis.

re: Medicare denying CPT® 82948

That's according to Medicare when I spoke with one of their specialist/representative.
When I used the code before, denied for the reason we don't have CLIA #.
We signed and now we have the CLIA #. Medicare said that we can re send all claim that was denied with this code 82948. And till now that was denied. And said that 82948 was not included in the CLIA waved test.
We used that code with icd 9 250.00, 250.03.

re: Medicare denying CPT® 82948

Is there any appropriate code instead of using this code 82948.
Pls need some advice from you guys.

re: Medicare denying CPT® 82948

You bill what you do:
From a CPT® coding perspective, code 82948 describes a blood glucose level that is determined by a reagent strip method. The blood is obtained and a drop of blood is placed on a glucose oxidase strip. The strip is blotted at a prescribed interval and the color of the strip (after it has been allowed to react with the blood) is visually compared against a color chart on the side of the vial that contains the unused reagent strips.

CPT® code 82962 describes the method when whole blood is obtained (usually by finger stick device) and assayed by glucose oxidase, hexokinase, or electrochemical methods and spectrophotometry using a small portable device designed for home blood glucose monitoring use. These devices may also be used in physician offices, during home visits or in clinics.
Did you use QW modifier on code 82948?
http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~Jurisdiction%2011%20Part%20B~Browse%20by%20Topic~Lab~8EELF34313?open&navmenu=Browse%5Eby%5ETopic%7C%7C%7C%7C
CLIA-waived tests that do not require HCPCS modifier QW are CPT® codes 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013 and 85651 and HCPCS code G0394

re: Medicare denying CPT® 82948

We billed for CPT® 82948 and put CLIA # in section# 23 of CMS form. They are denying it for the reason that CPT® 82948 is not included in CLIA waived test.
Was that the reason why they denied it, I need to use modifier QW?

re: Medicare denying CPT® 82948

Hi,
I submitted CPT® code 82948-QW but still denied. Adjustment Reason Codes
4 : The procedure code is inconsistent with the modifier used or a required modifier is missing. This change to be effective 7/1/2010: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.


What should the correct CPT® code

re: Medicare denying CPT® 82948

Medicare: There is limited coverage for this code: example once/month frequency.
Glucose Testing:
82948. Uncontrolled diabetes mellitus (250.02–250.03, 250.92–250.93).

re: Medicare denying CPT® 82948

We are a clia waived office and use "82962".
(The code 82948 is classified as a moderately complex test and therefore would be denied if you only have a PPM (provider-performed microscopy) certificate as you have stated. The code 82962, on the other hand, is a CLIA-waived test for which I believe you would qualify.

re: Medicare denying CPT® 82948

I have in mind to use 82962, but I'm worried if got to be denied again. Do I still need to put modifier QW?

re: Medicare denying CPT® 82948

So what is the latest on this? Did you get paid or not and what CPT® code you used? Did you use modifier QW?

re: Medicare denying CPT® 82948

82962 does not need QW modifier to be reognized as CLIA waived.