Does CPT code 86580 need a modifier?

If a preventive medicine service or problem oriented visit is done on the same day as the PPD placement, bill for the E/M service and the PPD placement. Modifier 25 shouldn’t be required on the E/M, since 86580 is a diagnostic test. But watch claims payment to be sure the payer’s edit system doesn’t require a modifier.

Is CPT 86580 covered by Medicare?

Medicare does pay for CPT code 86580 when the patient has had exposure to TB or has had a reaction to a recent TB screening test.

How do I bill for CPT 86580?

When billing code 86580 on the date the test is administered, use diagnosis code V74. 1 (special screening examination for bacterial and spirochetal diseases; pulmonary TB). The Centers for Medicare and Medicaid Services’ physician fee schedule says the national payment amount for code 86580 is $7.83.

Does CPT 86580 include reading?

Since the test is an inoculation screening test, rather than a vaccination, the test includes administering the skin test and you should not code separately for the administration. The Resource Based Relative Value System (RBRVS) does not include costs for a reading.

Can 96372 and 86580 be billed together?

96372 cannot be reported with 86580. Administration is inclusive.

How do you code for a PPD reading?

CPT code 86580 is reported for the Mantoux test using the intradermal administration of purified protein derivative (PPD). Except in unusual circumstances, a nurse will typically read the PPD test.

Who Should Bill modifier 90?

The 90 modifier is to be used when the billing laboratory refers a specimen to another lab for testing. In these cases, the billing lab is titled the “referring lab” while the lab that actually performed the test is the “reference lab.”

Can you bill for PPD reading?

Namely, that if a patient presents for interpretation of the results of a PPD (purified protein derivative of tuberculin) test, it is appropriate to report CPT code 99211.

When should modifier 90 be used?

Modifier 90 is used when laboratory procedures are performed by a party other than the treating or reporting physician and the laboratory bills the physician for the service. For example, the physician (in his office) orders a CBC, the physician draws the blood and sends the specimen to an outside laboratory.

On what type of code would the modifier 90 be appended?

Modifier 90 appended to a lab code (80000 series of CPT codes) indicates the lab procedure was performed by an outside party other than the treating or reporting provider. Lab work must be billed/submitted directly by the lab performing the lab test.