CPT CODE 99000, 99001 and 36415 with Modifier 59

Procedure Codes and Definitions


99000
Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory


99001 Handling and/or conveyance of specimen for transfer from the patient in other than a physician's office to a laboratory (distance may be indicated)

36415 Collection of venous blood by venipuncture


Laboratory Handling 

Laboratory handling and conveyance CPT codes 99000 and 99001 and HCPCS code H0048 are included in the overall management of a patient and are not separately reimbursed when submitted with another code, or when submitted as the only code on a claim for the same date of service.

Exceptions

Iowa Iowa providers are allowed to bill 99000 for lab services. Kansas Per Kansas State Regulations codes 84443, 85025, and 80053 can be billed separately and should not be denied into panel code 80050. Maryland Maryland allows payment of CPT 36416 when billed with an Evaluation and Management service. Michigan Michigan follows CPT direction regarding panel codes and requires all components of a panel to be submitted; these codes will be denied and will need to be resubmitted with the corresponding panel code. New Mexico Per New Mexico Medicaid State Regulations Drug Assay CPT codes 80320-80377 are considered non-reimbursable. These services may be reported under an appropriate HCPCS code.

Ohio Ohio follows CPT direction regarding panel codes and requires all components of a panel to be submitted; these codes will be denied and will need to be resubmitted with the corresponding panel code. Ohio allows payment of CPT 36416 when billed with an Evaluation and Management service.

Per state requirements, Ohio Medicaid and MME plans require that certain lab codes cannot be submitted with a modifier. The list of codes is included in the policy. Texas Texas allows reimbursement for CPT code 99000. Wisconsin Wisconsin allows payment of CPT 36416 when billed with an Evaluation and Management service for members ages 6 and under. Wisconsin allows reimbursement for CPT code 99000 & 99001.

BCBS Texas - Submission of CPT 99000 and 36415 with Modifier 59

Blue Cross and Blue Shield of Texas (BCBSTX) regularly evaluates the coding practices of physicians and other providers who submit claims for services. This includes issues such as bundling and use of CPT modifiers.

BCBSTX recently studied use of Modifier 59 (Distinct procedural service) with submission of CPT 99000 (Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory).  Because CPT 99000 is purely an administrative service and not a procedure, BCBSTX considers use of Modifier 59 for this code to be inappropriate.  This inappropriate use of Modifier 59 results in override of a claim system edit that considers CPT 99000 incidental to any other service performed on that date of service, including CPT 36415 for routine collection of venous blood, and results in an overpayment.  Please do not submit claims for CPT 99000 with Modifier 59.

Handling and Conveyance of Specimens

When a specimen is obtained and sent to an outside laboratory, the provider may add CPT code 99000 to the bill to describe the handling/conveyance of the specimen. The carrier shall reimburse $5.00 for this service in addition to the E/M service.

Miscellaneous Procedures

The following table outlines fees that are determined by the agency

99000 Handling or conveyance of specimen $5.00
99050 After hour (outside normal hours) office service (R 418.10202) $12.00
99199 Carrier arranged missed appointment (R 418.10112) BR
99199 -32 Carrier or requested report, per page (R 418.10114) $25.00
MPS01 Access Prescription Drug Monitoring Program (R 418.101008a) $25.00
WC700 -G Prescription drug dispense fee (R 912 & 101003a) – Generic $5.50
WC700 -B Prescription drug dispense fee (R 912 & 101003a) – Brand Name $3.50
WC700 -C Custom non-sterile compound dispense fee (R 418.101009) $12.50
99455 -32 Carrier requested visit for job evaluation (R 418.10404) $70.00
RN001 Rehabilitation or case manager visit (R 418.10121) $25.00


Special Services, Procedures and Reports in the Medicine Section of CPT

(a) Handling and conveyance of specimens in connection with a transfer from an office to a laboratory is a flat rate of $25.00 (CPT® codes 99000 and/or 99001). Any other handling and conveyance in connection with implementation of an order involving devices (such as orthotics) is a flat rate of $13.00 (CPT® code 99002).

 (b) Postoperative follow-up visit, CPT® code 99024, is included in the global package and is not separately payable.

 (c) Educational supplies are considered “at cost” to the provider and may be billed based upon an agreement between the payer and provider (CPT® codes 99070, 99071 or 99078).

 (d) Any stored clinical or physiological data analysis is not recognized unless the provider shows the reasonableness and necessity of these services and obtains prior authorization from the payer (CPT® codes 99090 and 99091).


(e) The charges for services performed after regular business hours, during holidays, or during scheduled disruptions of regular office services are not separately payable unless the provider shows the reasonableness and necessity of these services and obtains prior authorization (CPT® codes 99026, 99027, 99050, 99051, 99053, 99056, 99058, and 99060).

 (f) Unusual travel expenses require prior authorization by the payer. The payer and billing provider shall agree upon maximum fees (CPT® code 99082).

 (g) Medical testimony is covered under Rule 18-6(D) and special reports are covered under Rule 18-6(G)(3)&(4) (CPT® codes 99075 and 99080). (I) Physical Medicine and Rehabilitation (PM&R):



Handling fees, CPT codes 99000 and 99001

CPT codes 99000 and 99001 are designated as status B codes (bundled and never separately reimbursed) on the Physician Fee Schedule RBRVU file. Moda Health clinical edits will deny CPT 99000 or 99001 with explanation code WGO (Service/supply is considered incidental and no separate payment can be made. Payment is always bundled into a related service), whether 99000 or 99001 is billed with another code or as the sole service for that date. This edit is not eligible for a modifier bypass.

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