Many payers deny a handling fee (99000) when reported with a venipuncture (36415) or capillary stick (36416). For example, some payers deny the handling fee when a pap smear is obtained during an evaluation and management visit or a specimen is brought into the office by the patient (eg, 24-hour urine specimen). In these cases, it would be appropriate to report the handling fee because the specimen must be prepared for transfer to the laboratory.

Note that the Centers for Medicare and Medicaid Services Medicare program excludes payment for 99000 because it considers it a bundled service. Some state Medicaid programs will follow those rules. If a commercial payer does not pay for the handling of a specimen, appeal the denial and include a copy of the Current Procedural Terminology guidelines. Copy the state insurance commissioner on your appeal if appropriate. Negotiate with the payer, provide it with a summary...

You do not currently have access to this content.