Skip to Main Content
Issue Number - Name
0100-Add-on codes paid without Primary Code and/or denied Primary Code-by Clinical Laboratory
Review Type
Automated
Claim Type
Laboratory
Region and State
RAC 1-4
All States
Date Approved
2018-06-12

Description

CMS has designated certain codes as "add-on procedures". These services are always done in conjunction with another procedure and are only payable when an appropriate primary service is also billed. Clinical Laboratory providers paid for Add-On HCPCS/CPT codes without the required Primary code/or Denied Primary code will be denied.

Affected Code(s)

  • Primary: 81265, 81415, 81425, 81535, 82951, 86825, 87186, 87188, 87502, 87903, 88142-88154, 88164-88167, 88174-88175, 88172, 88184,
    17311-17315, 88302-88309, 88331, 88332, 88331, 88331, 88333, 88342, 88346, 88365, 88368, 88367, 88329-88334
  • Add-on: 81266, 81416, 81426, 81536, 82952, 86826, 87187, 87503, 87904, 88155, 88177, 88185, 88314, 88332, 88334, 88341, 88350, 8364,  88369, 88373, 88388

Applicable Policy References

  • Social Security Act, Section 1833 
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30 D 
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 01, Section 70 
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 16, Section 40.8 
  • CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 29, Section 240  https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Add-On-Code-Edits.html