Has anyone noticed that LabCorp changed their billing codes and charges for the Natural Killer Cell Functional Assay Testing at some point between July and September 2012?
In my situation it was changed from CPT code 88184 (x1) and CPT 88185 (x2), which is the industry standard coding for this type of Flow Cytometry testing, to CPT code 86849 Unlisted Immunology Procedure. Under the terms of my health plan, successful use of the unlisted procedure coding permits LabCorp to bill a larger amount, incur a smaller contractual discount amount as a preferred provider and consequently receive larger reimbursement payments from both the health plan and the insured.
My health plan has denied payment because unlisted codes, like CPT code 86849 can only be used when there is no other specific CPT code to describe the procedure. This result is the product of numerous appeals I have filed. The CPT codes LabCorp used prior to September 2012 are still approved by the AMA and available for LabCorp's use. Yet as of September 2013, LabCorp insists on using the unlisted procedure CT code 86849.
Is anyone else having trouble getting their insurance to pay on this lab test because of this change in CPT coding when there was no problem before September 2012? If so, please provide the details of your circumstances, thank you.
In my situation it was changed from CPT code 88184 (x1) and CPT 88185 (x2), which is the industry standard coding for this type of Flow Cytometry testing, to CPT code 86849 Unlisted Immunology Procedure. Under the terms of my health plan, successful use of the unlisted procedure coding permits LabCorp to bill a larger amount, incur a smaller contractual discount amount as a preferred provider and consequently receive larger reimbursement payments from both the health plan and the insured.
My health plan has denied payment because unlisted codes, like CPT code 86849 can only be used when there is no other specific CPT code to describe the procedure. This result is the product of numerous appeals I have filed. The CPT codes LabCorp used prior to September 2012 are still approved by the AMA and available for LabCorp's use. Yet as of September 2013, LabCorp insists on using the unlisted procedure CT code 86849.
Is anyone else having trouble getting their insurance to pay on this lab test because of this change in CPT coding when there was no problem before September 2012? If so, please provide the details of your circumstances, thank you.
