Genetic testing is becoming very popular. In fact, so popular you might see it in places you would not expect such as a community event, fairs or any event happening in your community. Some labs may even offer FREE screening for genetic testing. Watch for FREE screening announcements or advertisements stating how important it is to be screened for some of the following;
Hereditary cancer screening
Genetic testing fraud is a fraudulent scheme when someone bills Medicare or your insurance for a test that is not medically necessary. The OIG states these schemes involve $2.1 billion in losses.
Physicians: The OIG is investigating genetic testing fraud. Providers beware of what is covered with Medicare and what you are asking your patients to be screened for. Be sure you are aware of the benefits and coverage for Medicare Beneficiaries. While they may cover tests for diagnostic use, they generally only cover one preventative genetic screen for cancer.
Beneficiaries: If you were screened by someone, they may be sending your information to Medicare to receive payment. If it is not covered, you will be responsible and they will collect from you. They may even ask for your physician's information, stating they will send it to them. Never give your Medicare information out! They will tell you it is FREE because Medicare will cover it... I doubt it! You may receive a genetic test in the mail where they have you do a cheek swab and send it in with your Medicare information. Medicare does not do this; any tests must be ordered by your physician. Do not provide your Medicare information to anyone but your trusted physician's office.
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The use of Modifier 25 is one example ...
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Take a look at the following
J1071 - Injection, testosterone cypionate, 1mg
For example; using NCD # 0009-0085-10 there are 10 doses of 100 mL
(100 mg/mL = 1 mL and there are ...
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ICD-10-CM Official Coding Guidelines - ...
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