Is CPT 36415 covered by Medicaid?

CPT procedure code 36415 (collection of venous blood by venipuncture) was added as a covered service during the 2005 CPT code update. Medicaid will only reimburse for the collection of venous blood when a provider draws the blood and sends it to a non-related outside facility without performing any testing.

Does Medicare pay for 36415 venipuncture?

(Commercial and Medicare) Venous blood collection by venipuncture and capillary blood specimen collection (CPT codes 36415 and 36416) will be reimbursed once per patient per date of service when reported by the Same Individual Physician or Other Qualified Health Care Professional.

Does Medicaid use CPT codes?

HCPCS billing codes are monitored by CMS, the Centers for Medicare and Medicaid Services. They are based on the CPT Codes (Current Procedural Technology codes) developed by the American Medical Association.

Does Medicare cover routine venipuncture?

If you perform the lab test in your office, you may not bill separately for the “collection of venous blood by venipuncture,” or CPT code 36415, according to the Medicare Claims Processing Manual. The current allowable amount for routine venipuncture is $3.

Can CPT code 36415 be billed alone?

Multiple venipunctures (36410 or 36415) during the same encounter, to draw blood specimen(s), may only be billed as a single procedure with units of service = 1 (one) regardless of the number of attempts or veins entered.

What does CPT code 36415 mean?

collection of venous blood by venipuncture
CPT code 36415 describes collection of venous blood by venipuncture. Each unit of service (UOS) of this code includes all collections of venous blood by venipuncture during a single episode of care regardless of the number of times venipuncture is performed to collect venous blood specimens.

Can you bill for venipuncture?

Venipuncture is only eligible to be billed once, even when multiple specimens are drawn or when multiple sites are accessed in order to obtain adequate specimen size for the desired test(s).

What is procedure code 36415?

Description. 36410. VENIPUNCTURE, AGE 3 YEARS OR OLDER, NECESSITATING THE SKILL OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL (SEPARATE PROCEDURE), FOR DIAGNOSTIC OR THERAPEUTIC PURPOSES (NOT TO BE USED FOR ROUTINE VENIPUNCTURE) 36415. COLLECTION OF VENOUS BLOOD BY VENIPUNCTURE.

What is procedure code 99213?

CPT Code 99213: Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and a low level of medical decision making.

What is the CPT code for venipuncture?

Guidelines in parenthesis directly under CPT code 36592. Venipuncture or phlebotomy is the puncture of a vein with a needle or an IV catheter to withdraw blood. Venipuncture is the most common method used to obtain blood samples for blood or serum lab procedures, and is sometimes referred to as a “blood draw.”

Does Medicaid pay for 36415?

Medicaid will cover 36415 when blood is collected and sent to a non-related outside facility without performing any tests. Read the bulletin below and click on the link to go directly to the Medicaid NC website.

Is 36415 payable by Medicare?

CPT code 36415 for Collection of venous blood by venipuncture is now payable by Medicare, but code 36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick) remains as not payable by Medicare as a separate service.

Does Medicare cover 36415?

Medicare used to cover venipuncture with code 36415, but implemented the G code because 36415 included collection of blood through the finger, heel or ear stick – all services not covered by the program.

What is billing code 36415?

CPT Code 36415: Collection of venous blood by venipuncture Service code 36415 is routine venipuncture (blood draw) When blood is drawn to be sent to a reference lab, use code 36415 for the venipuncture.