CodeMap® 




2016 Lab Fee Schedule Updated     


2016 Physican Fee Schedule Updated 2/1/2016     


2016 July OPPS Fee Schedule Updated     


2016-C 7/1/2016 DME/PEN Fee Schedules Updated     


2016 July ASC Fee Schedule Updated     


Q3 2016 ASP Drug Pricing Updated     


Q3 2016 CCI Edits Loaded     


Q3 2016 MUE Edits Loaded     


7/1/2016 NCD Edits Loaded     


LCD Database Current Through 09/19/2016     

1901 North Roselle Road
Suite 640
Schaumburg, IL 60195
847-381-5465 Phone
847-381-4606 Fax
customerservice@codemap.com
      


User Information

Create New Account

Lost Password

Username:
Password:


Quick Links

Laboratory Fee Schedule

2016
2015

Physician Fee Schedule

2016
2015

OPPS Fee Schedule

2016
2015

ASC Fee Schedule

2016
2015

APC Codes

2016
2015

ASP Drug Pricing Files





87185
Quick jump to procedure code: Printer Friendly Version
87187

CPT® 87186: SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGAR DILUTION (MINIMUM INHIBITORY CONCENTRATION [MIC] OR BREAKPOINT), EACH MULTI-ANTIMICROBIAL, PER PLATE

Short Description: Microbe susceptible mic

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
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
2016 Laboratory Fee Schedule: $11.78

Revenue Code(s):
306-Laboratory-bacteriology & microbiology



2016 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.
PercentageICD-9ICD-10 Conversions
46.6% 599.0    Urinary tract infection, site not specified N39.0   Urinary tract infection, site not specified
4.8% 788.1    Dysuria R30.0   Dysuria
OR:
R30.9   Painful micturition, unspecified
2.3% 788.41    Urinary frequency R35.0   Frequency of micturition
2.1% 791.9    Other nonspecific findings on examination of urine R82.5   Elevated urine levels of drugs, medicaments and biological substances
OR:
R82.99   Other abnormal findings in urine
2.0% 599.70    Hematuria, unspecified R31.9   Hematuria, unspecified
1.7% 595.0    Acute cystitis N30.00   Acute cystitis without hematuria
OR:
N30.01   Acute cystitis with hematuria
1.5% V58.69    Long-term (current) use of other medications Z79.891   Long term (current) use of opiate analgesic
OR:
Z79.899   Other long term (current) drug therapy
1.2% 682.9    Other cellulitis and abscess, unspecified site L03.90   Cellulitis, unspecified
OR:
L03.91   Acute lymphangitis, unspecified
1.0% 780.60    Fever, unspecified R50.2   Drug induced fever
OR:
R50.9   Fever, unspecified
0.8% 686.9    Unspecified local infection of skin and subcutaneous tissue L08.9   Local infection of the skin and subcutaneous tissue, unspecified

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

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

87186 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 87186

CCI and MUE Edits*         Hide this section.

CCI Edits for 87186
Denied Codes (1)
Effective
Modifier
Accepted (2)
87181 Microbe susceptible diffuse
04/01/2002 Yes
87184 Microbe susceptible disk
04/01/2002 Yes
87185 Microbe susceptible enzyme
04/01/2002 Yes
87188 Microbe suscept macrobroth
04/01/2002 Yes
 
Denied Codes (1)
Effective
Modifier
Accepted (2)
87190 Microbe suscept mycobacteri
04/01/2002 Yes
88387 Tiss exam molecular study
07/01/2011 Yes
88388 Tiss ex molecul study add-on
07/01/2011 Yes
(1) These codes will be denied when submitted for payment on the same date of service as 87186.

(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.


Medically Unlikely Edits for 87186


Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 12 12 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Clinical: Data Clinical: Data Not Listed

* 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.


   87186 Top 5 Ordering Providers National*
BALKUNJE SHENOY -HUNTERSVILLE,NC 6,274
JON KELLER -PALO ALTO,CA 5,720
LESTER RAFF -WESTCHESTER,IL 4,409
YIJUN YANG -SYRACUSE,NY 4,310
FRANCIS VARGA -SPRINGFIELD,MO 3,904

   87186 Top 5 Ordering Organizations National*
ECCOLAB GROUP CO-FL 122,544
LABORATORY CORPORATION OF AMERICA HOLDINGS-NC 116,902
QUEST DIAGNOSTICS CLINICAL LABORATORIES INC-FL 82,848
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 80,331
LABORATORY CORPORATION OF AMERICA HOLDINGS-AL 73,996

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 87186*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2015: 3,128,194
Total Services Denied 2015: 264,637 (8.5%)
National Charges Submitted 2015: $158,539,074.00
National Charges Allowed 2015: $ 33,122,475.00
National Average (No Modifier) Fee Submitted 2015: $ 50.65
National Average (No Modifier) Fee Allowed 2015: $ 11.56
National Average (26) Fee Submitted 2015: $ 22.01
National Average (26) Fee Allowed 2015: $ 0.00
National Average (QW) Fee Submitted 2015: $ 63.50
National Average (QW) Fee Allowed 2015: $ 0.00


Top 5 Performing Specialties 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
2,961,614 94.7% $ 51.58 254,409 8.6%
Pathology 39,532 1.3% $ 36.32 1,637 4.1%
Urology 38,222 1.2% $ 34.98 1,866 4.9%
Family practice 32,836 1.0% $ 33.32 3,331 10.1%
Internal medicine 24,469 0.8% $ 31.32 955 3.9%

Top 5 Places of Service 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 2,921,083 93.4% $ 51.81 251,009 8.6%
Office 174,340 5.6% $ 35.94 8,746 5.0%
Skilled nursing facility 15,148 0.5% $ 28.02 2,257 14.9%
Nursing facility 14,544 0.5% $ 25.88 1,486 10.2%
Urgent Care Facility (eff. 1/1/03) 862 0.0% $ 50.75 297 34.5%

Top 5 Modifiers Submitted 2015 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 2,704,239 86.4% $ 50.65 215,965 8.0%
90 - Reference (Outside) Laboratory 138,998 4.4% $ 57.19 15,262 11.0%
91 - Repeat Clinical Diagnostic Laboratory Test 135,163 4.3% $ 44.77 15,811 11.7%
59 - Distinct Procedural Service 74,851 2.4% $ 52.80 8,966 12.0%
GW 30,794 1.0% $ 34.11 1,402 4.6%

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.

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.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.
09/28/2016 08:37:17 54.196.145.173

CodeMap¨ is a Registered Trademark of Wheaton Partners, LLC.