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2018

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CMS Transmittals




36410
Quick jump to procedure code: Printer Friendly Version
36416

Procedure Category: Surgery
Procedure Subcategory: Cardiovascular System

36415: ROUTINE VENIPUNCTURE

CPT® 36415: Collection of venous blood by venipuncture



--

CPT copyright 2017 American Medical Association. All rights reserved.


2018 Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
MINNESOTA-Entire State
MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State
2018 Laboratory Fee Schedule: $3.00


2018 OPPS Status Indicator: Q4

Effective April 1, 2013, and while sequestration is in effect, all CMS payments for services will be reduced by 2%. The fees above do not reflect this reduction. Click here for more information.

Commonly Associated Diagnosis Codes*            Hide this section.
Percentage
ICD-10 Code
Description
Related DRG(s)
11.1%
I10
Essential (primary) hypertension
304-305
6.6%
E11.9
Type 2 diabetes mellitus without complications
008
010
637-639
4.6%
E78.5
Hyperlipidemia, unspecified
642
3.2%
E03.9
Hypothyroidism, unspecified
643-645
2.5%
Z79.01
Long term (current) use of anticoagulants
949-950
2.4%
Z79.899
Other long term (current) drug therapy
949-950
2.4%
D64.9
Anemia, unspecified
811-812
2.3%
I48.91
Unspecified atrial fibrillation
308-310
793
2.2%
E780
This diagnosis code is no longer active.
2.1%
E78.2
Mixed hyperlipidemia
642

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

36415 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New

Column 1 CCI Edits for 36415
Denied Codes (1) Effective Modifier
Accepted (2)
36591 DRAW BLOOD OFF VENOUS DEVICE 10/01/2015 No
36592 COLLECT BLOOD FROM PICC 10/01/2015 No
99211 OFFICE/OUTPATIENT VISIT EST 04/01/2014 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 36415.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.



Column 2 CCI Edits for 36415
Denied Codes (1)
Effective
Modifier
Accepted (2)
0232T NJX PLATELET PLASMA
01/01/2018 Yes
0481T NJX AUTOL WBC CONCENTRATE
01/01/2018 Yes
99291 CRITICAL CARE FIRST HOUR
01/01/2008 Yes
99466 PED CRIT CARE TRANSPORT
01/01/2009 Yes
99467 PED CRIT CARE TRANSPORT ADDL
01/01/2014 Yes
99468 NEONATE CRIT CARE INITIAL
01/01/2009 Yes
99469 NEONATE CRIT CARE SUBSQ
01/01/2009 Yes
99471 PED CRITICAL CARE INITIAL
01/01/2009 Yes
99472 PED CRITICAL CARE SUBSQ
01/01/2009 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
99475 PED CRIT CARE AGE 2-5 INIT
01/01/2009 Yes
99476 PED CRIT CARE AGE 2-5 SUBSQ
01/01/2009 Yes
99477 INIT DAY HOSP NEONATE CARE
01/01/2008 Yes
99478 IC LBW INF < 1500 GM SUBSQ
01/01/2009 Yes
99479 IC LBW INF 1500-2500 G SUBSQ
01/01/2009 Yes
99480 IC INF PBW 2501-5000 G SUBSQ
01/01/2009 Yes
99485 SUPRV INTERFACILTY TRANSPORT
01/01/2013 Yes
99486 SUPRV INTERFAC TRNSPORT ADDL
01/01/2013 Yes
G0471 Ven blood coll snf/hha
07/01/2015 No
(1) These codes will be denied when submitted for payment on the same date of service as 36415.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


2018 Medically Unlikely Edits for 36415


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 2 2 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: CMS Policy CMS Policy Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   36415 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
DEREK WELCH -BRENTWOOD,TN 105,174
JON KELLER -PALO ALTO,CA 96,835
WILLIAM MORICE -ROCHESTER,MN 93,906
TERENCE CASEY -BRENTWOOD,TN 44,350
EDMUND TAI -MOUNTAIN VIEW,CA 43,802

   36415 Top 5 Ordering Organizations National*
LABORATORY CORPORATION OF AMERICA HOLDINGS-NC 1,434,194
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 1,209,713
QUEST DIAGNOSTICS CLINICAL LABORATORIES INC-FL 876,591
SONORA QUEST LABORATORIES, LLC.-AZ 701,432
UNILAB CORPORATION-CA 616,962

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 36415*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 52,834,759
Total Services Denied 2017: 2,760,978 (5.2%)
National Charges Submitted 2017: $840,619,400.45
National Charges Allowed 2017: $150,208,981.68
National Average (No Modifier) Fee Submitted 2017: $ 15.94
National Average (No Modifier) Fee Allowed 2017: $ 3.00
National Average (26) Fee Submitted 2017: $ 4.66
National Average (26) Fee Allowed 2017: $ 0.00
National Average (QW) Fee Submitted 2017: $ 12.05
National Average (QW) Fee Allowed 2017: $ 0.00
National Average (TC) Fee Submitted 2017: $ 15.40
National Average (TC) Fee Allowed 2017: $ 0.00


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
25,585,459 48.4% $ 17.63 1,506,585 5.9%
Internal medicine 7,934,752 15.0% $ 14.37 339,842 4.3%
Family practice 7,476,722 14.2% $ 14.00 380,825 5.1%
Hematology/oncology
(eff 5/92)
2,993,600 5.7% $ 14.99 101,278 3.4%
Nurse practitioner 1,549,346 2.9% $ 14.59 98,685 6.4%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Office 27,114,593 51.3% $ 14.30 1,189,469 4.4%
Independent laboratory 23,743,042 44.9% $ 18.19 1,353,962 5.7%
Home 695,769 1.3% $ 10.24 41,712 6.0%
Nursing facility 611,101 1.2% $ 10.88 61,863 10.1%
Skilled nursing facility 226,928 0.4% $ 11.22 33,278 14.7%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 52,127,972 98.7% $ 15.94 2,715,176 5.2%
59 - Distinct Procedural Service 246,899 0.5% $ 16.38 17,990 7.3%
GA - Advanced Beneficiary Notice (ABN) on File 235,927 0.4% $ 11.52 7,917 3.4%
GW 58,007 0.1% $ 11.42 2,782 4.8%
Q1 33,595 0.1% $ 15.50 1,278 3.8%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


   CodeMap Compliance Briefings: Hide this section.

CMS Transmittals Referencing "36415"
Issue DateTransmittalTitle
2018-07-20 R4090CP Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
2018-05-11 R4045CP Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
2018-03-21 R4006CP April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1
2018-03-14 R3999CP Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
2018-03-02 R3989CP April 2018 Integrated Outpatient Code Editor (I/OCE) Specifications Version 19.1
2017-12-15 R3934CP Calendar Year (CY) 2018 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
2017-05-12 R1846OTN MCS Implementation of the Restructured Clinical Lab Fee Schedule


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

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10/19/2018 11:40:53 54.224.150.24

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