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Our billing department is dedicated to answering all types of client, patient, and third-party inquiries. The phone numbers listed above will provide you or your patient’s access to trained customer service representatives. Please call at any time during normal business hours.
MEDICAL NECESSITY – MEDICARE
The Centers for Medicare and Medicaid Services (CMS) is responsible for ensuring that services being paid for by the Medicare program are medically necessary. CMS has created national edits called National Coverage Determinations (NCDs), which require documentation of medical necessity before a claim may be paid. In addition, local carriers maintain a list of Local Medical Review Policies (LMRPs) that also require documentation of medical necessity.
Local Medicare carriers have the authority to deny claims when the diagnosis code(s) provided for a test does not substantiate medical necessity. If a physician does not submit a covered ICD-9 code for an NCD or LMRP, AMS will contact the physician’s office to request a diagnosis indicating medical necessity. If a covered diagnosis code is not available, AMS will expect a completed Advanced Beneficiary Notice to be attached to the requisition in order to bill the patient. Directions for completing the ABN are on the requisition. If an ABN has not been completed, AMS will bill the client.
Tests that are subject to NCDs and LMRPs are printed in red on the requisitions. The Medicare carrier may approve additional LMRPs for other laboratory tests at any time. You can access the Medicare Coverage Database at www.cms.gov/medicare-
CPT codes listed in this Service Guide are provided only as guidance to assist you in billing. CPT codes listed reflect our interpretation of CPT coding requirements and are subject to change at any time. It is the client’s responsibility to verify the accuracy of the codes. If you have questions, please refer to the Current Procedural Terminology (CPT) manual published by the American Medical Association.
COVID-19 PRICING TRANSPARENCY
In accordance with provisions in the CARES Act, COVID test prices are published below.
Please keep in mind:
-If you have insurance, please know many insurance plans cover COVID-19 diagnostic testing at no cost to the patient.
-The actual price you pay will likely be lower than the price listed on this page because the prices listed do not take into the account insurance coverage or other financial assistance.
-If you do not have insurance, please know that as part of the FFCRA, PPPHCEA, and CARES Act, The U.S. Department of Health and Human Services (HHS) is providing reimbursement to healthcare providers for testing of uninsured individuals for COVID-19. If you don’t have insurance, Affiliated Medical Services Laboratory will submit a claim to the federal government, and they will likely cover the expense of your specimen collection, test, and testing-related visits.
-COVID-19 diagnostic testing options are rapidly changing, and therefore tests and prices are subject to change. Our published price list is accurate as of 11/2/2020.
|TEST NAME||Description||TEST CODE||Billing Code (CPT)||Non-Client Price/Cash Price|
|SARS-CoV-2- ref lab||Infectious agent detection by nucleic acid (DNA or RNA);severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Coronavirus disease [COVID-19]),amplified probe technique||QG191||87635||$125.00|
|COVID-19 IgG||Antibody;severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)(Coronavirus disease [COVID-19])||COVG||86769||$43.00|