Coding and reimbursement can be tricky to navigate when patch testing, and let’s be honest, it’s not how you want to be spending your time. To help you spend more time giving patients the diagnosis that they deserve, below is a quick FAQ on your most asked coding and reimbursement questions:
Can I bill for the negative control on T.R.U.E. TEST?
Yes, you should bill CPT code 95044 for 36 units as this is a standardized test and the negative control is required by FDA.
Does Medicare have different requirements than Commercial Insurance?
Medicare requires two lines when billing more than 90 units. You should also use modifier 59 on the second line when billing Medicare. Typically, most commercial insurance companies do not require a modifier or second line.
Why do we get zero RVUs for the patch testing?
If there is a zero RVU amount, this means there is no fee schedule/agreement with the insurance contract set up.
Is there a template available for a letter of medical necessity?
Yes! See below. Please use the following guidelines when submitting a letter of medical necessity:
- The diagnosis must be specific. For example, a diagnosis of “fatigue, bone pain or weakness” is not specific – a diagnosis of “Osteoporosis” is specific.
- The recommended treatment must be named and described in detail by a licensed health care provider. A recommended treatment described,as “quitting smoking, healthier diet and regular or daily exercise recommended” does not provide enough information. Your provider must specifically name and describe the recommended treatment. An acceptable description of treatment would be “I recommend 800 IU of Vitamin D and 1200 mg of Calcium supplements each day for the next 6 months to slow down the patient’s Osteoporosis progression.”
- Your provider must state a specific length of treatment. Lifetime or indefinite lengths of treatment will not be approved.
Copy and then edit the below text:
Practice Address Cont.
Re: Patient Name
To Whom It May Concern:
I am writing on behalf of my patient, (patient name) to document the medical necessity of (treatment/medication/equipment – item in question) for the treatment of (specific diagnosis). This letter provides information about the patients medical history and diagnosis and a statement summarizing my treatment rationale.
Patient’s History and Diagnosis:
(Include information here regarding the patient’s condition and specific diagnosis. Also include the patient’s history related to their condition)
(Include information on the treatment up to this point, course of care and why the treatment/medication/equipment (item in question) is necessary and how you expect that it will help the patient.)
(Length of time treatment/medication/equipment (item in question) is necessary – not to exceed 12 months)
In summary, (treatment/medication/equipment – item in question) is medically necessary for this patient’s medical condition. Please contact me if any additional information is required to ensure the prompt approval of (treatment/medication/equipment – item in question).
(Physicians name and signature) Your licensed provider must complete, sign and date the the letter.
What do you suggest coding for metal patch testing? We find that Medicare is very difficult to deal with and most of those patients are coming in before orthopedic surgery.
Coding and billing for patch testing is the same across the board and is not dependent on the substances that are being tested. Unfortunately, Medicare only allows up to 84 allergens to be tested at a time. If you are denied by Medicare, a letter of medical necessity may be required, and/or a pre-authorization.
Disclaimer: The brief information included here about coding and reimbursement is for educational purposes only. It should not replace current Medicare or specific payer policies, state or federal regulations, medico-legal practice guidelines or consultation with coding experts or attorneys. Users should always consult payers for final guidance and about changes in coding and reimbursement practices. SmartPractice® and SmartPractice Denmark® assume no liability from the use of this manual.
For more details on patch test reimbursement, contact our customer service department at 1-800-878-3837