Original Effective Date:
08/01/1994
Current Effective Date:
01/01/2015
Skin Testing
Skin testing is covered once per benefit year (January – December) for adults and as needed for children. Tuberculin (TB) Risk Questionnaire is also covered. If an adult patient fails to return for the reading and needs to retake the test, the patient is responsible for the cost of the second test. This must be explained to the patient and the patient must sign a financial responsibility statement before the second test is done. An exception is made if the initial test results are positive or inconclusive. This information must be noted on the claim for the second testing to help ensure processing of the claim.
Claims Filing Information
Use the appropriate CPT-4 code describing the service provided. The fee paid for the testing includes the reading of the test results. A separate visit to read the results is not payable.
There is no corresponding procedure code for the TB Risk Questionnaire. Claim should include any service(s) actually rendered (e.g., if the primary reason the patient saw the provider was to get a TB clearance, claim would be billed for a low-level evaluation and management visit such as 99211, etc.), and regular plan benefits would apply.
When testing children as part of an EPSDT screening exam, the testing is included as part of the global fee reimbursement for EPSDT and should not be billed separately.
If this is a second test for an adult because the initial test was positive or inconclusive, include a notation in field #19 to explain the reason for the test.
Treatment of Tuberculosis
Treatment of pulmonary and extrapulmonary infection (mycrobacterium tuberculosis) is not covered. This includes visits, laboratory testing, X-rays and drugs after the diagnosis is confirmed. Patients should be referred to the appropriate Department of Health clinic on their island of residence for treatment.