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NK Cell Function Test and Medicare

Discussion in 'Immunological' started by acer2000, Nov 1, 2013.

  1. acer2000

    acer2000 Senior Member

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    For those of you who have had your NK cell function tested (also known as NK cell cytotoxicity) and who have Medicare, have they generally paid for this test? If so, do you know what lab your doctor used? Did you have to appeal?
  2. minkeygirl

    minkeygirl Is Jim Jones alive and well on PR?

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    I just had a boatload of texts run. I know one was NK Cell, but not sure that specific one. I did not have to pay for any with Quest.

    I think if your doctor requests it then they cover it.

    Mink

    I'm in an HMO so labs are covered 100%. If you are on straight Medicare and coverage is 20% (not sure) then I think it would still be covered.
  3. Nielk

    Nielk

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    I had cell natural killer cell function test through Quest. Medicare covered it with no problems.
  4. August59

    August59 Daughters High School Graduation

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    If the doctor specifies the right diagnosis they have to pay unless there is another test that is less expensive, but might not tell you as much. The doctor should be well aware of this.
  5. acer2000

    acer2000 Senior Member

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    This was through labcorp. Medicare has paid for this test in the past. I think something is different this time about the CPT code. The ICD codes used by my doctor are the same. I have been trying to get info out of labcorp, but it has been difficult.

    I am pretty sure the test is actually done via either Focus Diagnostic or Viracor, but collected and sent via Labcorp due to the arrangement by my doctor (who uses Labcorp).

    Here is the info from Focus and Viracor:

    http://www.focusdx.com/focus/1-refe...=1&S2=1&test=&sp=20595&Keyword=20595#an_20595

    http://www.viracoribt.com/Test-Catalog/Detail/Natural-Killer-Cell-Function-Assay

    Links to the same test done via Quest (who appears to send to Focus):

    http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=34184

    All of those tests reference CPT codes 88184 (x1) 88185 (x2), and this is what my test was submitted with (and paid for) last year. But it would appear that it was submitted to my insurance as CPT code 86849 this time.

    Does anyone know who decides what CPT code gets sent to the insurance? Is it labcorp (blood drawers), Focus or Viracor (reference lab that actually does the test), or maybe the doctor?
    Last edited: Nov 3, 2013
  6. NVCFS2005

    NVCFS2005

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    In my case, LabCorp sends the test to Viracor. Since LabCorp is the Provider they are responsible for billing the insurance with the appropriate CPT code. Until September 2012 LabCorp used the CPT codes 88184 (x1) 88185 (x2) and my insurance paid. When they switched to 86849 my insurance stopped.

    The Unlisted Immunological Procedure code (86849) is to be used ONLY when no other code is available. The AMA still lists CPT codes 88184 and 88185 as the appropriate codes to be used for Flow Cytometry. In our case the NK Cell Functional Assay. The labs that perform this test still list 88184 and 88185 as the CPT code to be used when billing as you have referenced in your post above.

    Our efforts to get information and documentation from LabCorp has fallen on deaf ears. We had to appeal through our insurance. In our Level 1 appeal, LabCorp told our insurance company that the AMA made them change their internal codes and when that happened they could no longer use the CPT codes 88184 and 88185.

    Since all the labs that perform this test still list 88184 and 88185 as the CPT codes to be used for this test, we have filed a Level 2 appeal.
  7. Spinney Lainey

    Spinney Lainey Senior Member

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    Are you guys from UK? Surely you can't get this tested on NHS??
  8. NVCFS2005

    NVCFS2005

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    No. This issue involves a large lab in the USA.
  9. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    australia (brisbane)
    Redlabs in belgium I think do it??
  10. August59

    August59 Daughters High School Graduation

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    LabCorp owns Viracor. LabCorp usually sends all their viral test, at least for titres on EBV and HHV6, to Viracor for a confirmation on their test. Viracors usually comes back higher.
  11. acer2000

    acer2000 Senior Member

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    I can't find any reference showing that Labcorp owns Viracor. Can you provide a link?

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