BILLING NEWS

Immunoassay for Tumor Antigen: Reimbursement Update

Effective for dates of service on or after October 1, 2009, CPT-4 code 86304 (immunoassay for tumor antigen, quantitative, CA 125) is reimbursable only when billed in conjunction with one of with the following ICD-9-CM diagnosis codes:

  • 150.5
  • 150.9
  • 151.0 - 151.9
  • 153.0 - 153.5
  • 153.8 - 153.9
  • 154.0 - 154.1
  • 156.8 - 156.9
  • 157.0 - 157.2
  • 157.8 - 157.9
  • 158.0
  • 158.8 - 158.9
  • 159.9
  • 162.2 - 162.3
  • 162.5
  • 162.8 - 162.9
  • 163.0
  • 163.1
  • 163.8 - 163.9
  • 174.0 - 174.6
  • 174.8 - 174.9
  • 175.0
  • 175.9
  • 179
  • 180.0 - 180.1
  • 180.8 - 180.9
  • 182.0 - 182.1
  • 182.8
  • 183.0
  • 183.2 - 183.5
  • 183.8 - 183.9
  • 184.0 - 184.4
  • 184.8 - 184.9
  • 198.6
  • 198.82
  • 230.3
  • 233.0 - 233.3
  • 236.0 - 236.3
  • 239.3
  • 338.3
  • 620.0 - 620.2
  • 789.30
  • 789.39
  • 795.82
  • 795.89
  • V10.00
  • V10.05
  • V10.09
  • V10.3
  • V10.40 - V10.44
  • V66.2
  • V67.1
  • V67.2

The frequency limit for code 86304 is twice per month for the same recipient and month of service. Claims billed using code 86304 without one of the above ICD-9 CM diagnosis codes will be denied.


SOURCE: California Medi-Cal
INDUSTRY NEWS TAGS: California Medi-Cal


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