Yes I get paid $65.51 for RSV as minimum. Its actually what made me switch to the molecular testing. regular rapid test are a loss all payors.
Thank you. So you are saying, Molina Star + Chip pay for Flu, Strep, and RSV molecular. The CPT I have used is 87634
Molina openly says they do not pay any molecular tests. I have not received any payment on them for FLU, RSV, STREP, or COVID. Which I feel is criminal because every Medicaid in Texas does except them. (How do they get away with that when Traditional Medicaid approved those codes years ago and still pay them)?
Have you tried appealing to the State?
Yes, I started the appeals process last January. At first they said yes they should have been paid. Then I received this email.
"I apologize for the delay. After further review it was determined the following CPT codes 87634, 87651 & 87502 denied correctly.
Please see the attached list of lab codes that can be performed in the office. Any code that is not listed must be referred to an In-Network lab Provider that is a certified , full service laboratory offering compressive test menu that includes routine, complex, drug, genetic testing and pathology.
The CPT codes that you listed below are not covered under labs that can be performed in the office.
This information can be found on Molinaās Website under Frequently Used Forms. Link: https://www.molinahealthcare.com/providers/tx/marketplace/forms/Pages/fuf.aspx
Thank you,
Sandra Salas"
We get the same kickback from Texas Childrenās on what test we can do in office. Why donāt you send an appeal to state and see what happens, especially now when its COVID season. We stopped doing Biofire a few years back due to pushbacks and I heard that Superior lifted their prior auth. requirements ( and reinstated it again) for COVID. I also heard that Molina lost their Star contract last year.
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Here in AZ same issue. Molecular testing codes are only payable for commercial labs for our Medicaid population and not office based labs. We plan to use our molecular tests on for insurance patients but not Medicaid. Unfortunately, we are forced to send them to the lab for testing. I have appealed to our Medicaid rep but no luckā¦told to send to commercial lab.
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If you do a POC COVID test on a child with respiratory symptoms, are you getting paid if you use ICDs for say URI ONLY, or you must use one of the new Z20.828 or Z03.818 codes to get paid for the COVID test? Have you got paid for Z11.59?
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These are all good codes. Have not used them all but as far as I know theses should work.
| A41.89 | Other specified sepsis |
|---|---|
| O98.511 | Other viral diseases complicating pregnancy, first trimester |
| O98.512 | Other viral diseases complicating pregnancy, second trimester |
| O98.513 | Other viral diseases complicating pregnancy, third trimester |
| O98.519 | Other viral diseases complicating pregnancy, unspecified trimester |
| O98.52 | Other viral diseases complicating childbirth |
| O98.53 | Other viral diseases complicating the puerperium |
| R05 | Cough |
| R06.02 | Shortness of breath |
| R50.9 | Fever, unspecified |
| U07.1 | COVID-19 |
| Z03.818 | Encounter for observation for suspected exposure to other biological agents ruled out |
| Z09 | Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm |
| Z11.59 | Encounter for screening for other viral diseases |
| Z20.828 | Contact with and (suspected) exposure to other viral communicable diseases |
Hi
Is anyone willing to sell us a box of Abbott ID Now COVID tests p/n 190-000? We do have the ID system and FLU cartridgesā, have not jump into the COVID contract.
Appreciate!
Good Luck. We were promised cartridges by end of Sept and 2 months later ZERO delivered.
Have other received their orders for Covid-19 tests on the Abbott ID NOW?
We are getting a few boxes of tests in here and there but they donāt last long. We were also promised the end of Sept but finally got our first box the middle of Nov. Have gotten Flu A/B, RSV, and Strep with no issues but COVID is a different story.
Same here for the Abbott molecular covid tests. We got one small shipment several weeks ago that we rationed out and none since. we just do 48 hr PCR send outs to lab in Birmingham now. No problems with getting any other tests from Abbott like the flu/rsv or strep. Most of the urgent care clinics around here seem to be doing antigen testing and seem to have no shortage of tests for our patients who go there.
Dbrown (Alabama)
Everyone should also look into āmachine lessā tests like Carestart by Accessbio. It gives results in 10 minutes. (https://www.cliawaived.com/carestart-covid-19-antigen-tests.html). I will be trying out Carestart soon. They have the lowest prices but I will test the specificity and sensitivity.
I know antigen tests arenāt considered the gold standard right now but I think these tests are worth a shot. Do you know what the billable CPT code is so I can check reimbursement for these?
Regardless of Fee schedule, for us reimbursement is all over the place. United, Cigna & Aetna paying well for Molecular Flu - using Antigen for the rest + Medicaid. On COVID - only some paying for the antigen (United, Cigna + BCBS), all other have a list of excuses. No experience billing Molecular-COVID. Currently doing Telemedicine and either swab at designated parking spot and sent out to external lab or direct patients to test drive throughs set up by local Health Department.
Flu - 87502
Strep 87651
RSV 87634
COVID 87635
Antigen (BD, SOFIA)
Flu 87804
Strep 87880
COVID 87426
We ordered 3 kits of the CareStart and will begin using them this week. We were told that the CPT is 87811 so weāll see how it goes!
It is a little odd that the percent agreement for positive is 88% and the negative is 100%. The doctors all think this would be the other way around. Thoughts?
The CARESTART PPV and NPV data is correct. We got PPV of 86% and NPV of 98 for Sofia antigen tests. The sample size was 1425. Bottom line, there are very few false negatives, but a lot of false positives. Are you getting paid for 87811?