CERT Error Relating to Billing of Venipuncture (36415)

The CERT error report has identified CPT® 36415, the collection of venous blood by venipuncture, being submitted as a covered service when the associated lab service is submitted as non-covered. If a provider chooses to submit a lab service with non-covered charges, the associated venipuncture code must also be submitted as non-covered for proper claim processing. In addition, if the same provider completes the venipuncture and lab service, the charges must be combined on the same claim.

Frequently, providers draw a lab specimen, but send the specimen to another facility for processing of the specimen. It is important the provider drawing the lab specimen review the Medicare coverage for the lab service. If Medicare will not cover the lab service, the provider drawing the lab specimen should submit the venipuncture charge as a non-covered service.

An understanding of CERT is critical to providers. While billing errors result in a partial or full denial of payment for procedures and services, the impact of CERT on providers extends beyond potential errors. Additional data may be collected on CERT-identified errors, resulting in possible implementation of focused reviews. Also, referrals may be made to other agencies or NAS departments for recovery, education or review.

Applies to the states: AK, ID, MN, ND, OR, UT & WA