Biofire Blood Culture PCR Panel 2 MUEs

kay.larsen@ah.orgkay.larsen@ah.org
in BILLING AND CLAIMS

What is the best CPT code to use for Biofire Blood Culture PCR Panel 2? It can be 40-43 Targets

Lab is dropping 40 charges for 87150 but the MUE is 12 (MAI3) so we're writing off 28 charges. Is there another code? Just doesn't make sense to have to write off so many units for a pre-packaged cartridge.

I thought about 87154, which is for 6 or more cultures or isolates. The MUE is 12 MAI3. If this is the right code, do we get to post 1 quantity for 6 or more cultures AND 1 quantity for 6 or more isolates?

Clueless in California,

Kay

Comments

  • dwilliamsrsidwilliamsrsi

    Are they dropping the charges because all are medically necessary? or are they dropping all charges because that is what is included in the pre-packaged cartridge? Many payers (not just CMS) are balking at being charged for so many targets because there is no medical necessity for all of the testing. They view it from the documentation standpoint - if the patient has symptoms that cover 10 of the targets, why should they pay for additional 30 targets (in your example) just because they are part of the cartridge that the company supplies and the facility uses? While we know that some MUEs appear to be unreasonable, non-Medicare payers have the same thoughts. One payer suggested that the provider consult with the manufacturer and obtain a cartridge with a more limited number of targets included.

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