Maxine, I spent a long time on the phone with medicare trying to discover this. After being transferred from one person to another for a while and waiting a long time, someone finally came on the line and told me that medicare never, ever says ahead of time what will be covered and what will not. She said you have to have the test and bill medicare. Then, when they receive the bill, they will decide if your test is "medically necessary". If they decide it is, they pay. If they decide it is not, they do not pay. Note: I am referring to original medicare. I do not know what medicare advantage plans do.
If Medicare pays anything toward this test, I doubt that it will pay the entire cost of the test. I've contacted VIP DX on this issue, but their answer is not clear at all to me. As I understand, if a lab or doctor is a Medicare participating provider, they have to accept Medicare's assignment, or in some states are allowed to charge 15% over the assignment amount. VIP DX says that they have a Medicare provider number, but they are not a "preferred" provider. I don't know what that means. They say that they are a fee-for-service provider. As a courtesy they will bill Medicare and secondary insurance, but cannot guarantee that Medicare will pay anything, and that the patient is responsible for any and all portions not paid by Medicare.
I don't understand how VIP Dx can have a Medicare provider number, and not abide by Medicare's rules of assignment or the 15% over assignment, if allowed.
So I think if you decide to take this test, that you better be prepared to pay the full bill. I'm in the same boat, i.e. I have Medicare and can't afford the tests if VIP Dx will not accept Medicare assignment.
I think it's unconscionable for labs that specialize in ME/CFS tests and doctors who specialize in ME/CFS research who will not accept Medicare assignment. They are basically turning their backs on the most severely disabled ME/CFS patients who are on Medicare and struggling to survive on near poverty level social security disability benefits.
I called Medicare yesterday and the CPT code 87798 if for infectious agent detection by nucleoic acid. I was told by the Medicare rep that this code is usually paid for if the right diagnostic code is given. I wonder if VIP can give us the right diagnostic code? I'm still trying to decipher what code my doc wrote. I may have to pull out a magnifying glass.
I agree I wnt to do it correctl so that Medicare pays for the testing. No reason to submit incorrectly and then have to pay for it ourselves! I'll call VIP Monday morning or e-mail them this weekend. I'll post whatever info I find.
I have never posted before, but I'm finally motivated. I had my xmrv blood drawn last thurs., so the VIP labs would have run it last Friday (a week ago). The (very nice and efficient) Megan said I would get the results in 2 weeks. It sounds like they've gotten way off from this time frame in just a short period of time. Has anyone waited more than 2 weeks after they did their blood draw?
although my question has still not been answered. I also posted the CPT code and posted the explanation from Medicare what that code referred to. My question is about the correct diagnosis code, which I know comes from the doctor.
Medicare will only pay for the test if the diagnosis code matches what they consider to be the correct codes. My question is does anyone know what Medicare considers to be the proper diagnosis code, or codes? I assume that there are more than one acceptable code. Most doctors have not ordered the xmrv test in the past so if anyone knows I would greatly appreciate your input. Thanks!