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Asymptomatic but wants a COVID test? Press for medical necessity in notes, use Z-code, Part B News, ft. Abbye Alexander

Posted Oct 6, 2020

Abbye Alexander, partner and co-chair of the KDV Health Care/Managed Care practice group, was quoted in a Part B News article – page 8 Ask Part B News – published on October 5, 2020.

Question: My patient is visiting aged relatives and wants a COVID test before she goes to reduce the chance of infecting them. How should I code this? And will Medicare deny the charge for lack of medical necessity, as my patient lacks any symptoms?

Answer: Despite the public health emergency (PHE) enduring for more than six months, a lack of clarity around testing — and whether the testing will get reimbursed — remains.

“CMS has not established a national policy, either through rulemaking or a national coverage determina­tion, regarding when COVID-19 testing is necessary and therefore the medically necessary standard is applicable for coverage,” says Abbye E. Alexander, co-chair of the health care/managed care practice group at Kaufman Dolowich & Voluck in Orlando, Fla. “Absent national policy, coverage of these tests is determined by the Medicare administrative contractors [MACs] themselves.”

But there are diagnosis codes and CPT codes that you will want to make sure you apply, and your provid­ers should make the best possible case for necessity.

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