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PAP238

Newborn Metabolic Screening Kit


Provider Administrative Policy

Section
Claims Submission
Policy Date
December 2006
Status/Date
Revised/October 2011
Provider Type(s)
Hospitals   Physician  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Newborn Metabolic Screening Kit

Newborn Metabolic Screening (sometimes referred to as the PKU test) tests are given to infants during their hospital stay. Blue Cross of Idaho will reimburse the facility when benefits allow.

If a physician's office needs to submit the service, they should use HCPCS code S3620 and include in the narrative if a single or double kit was given. Blue Cross of Idaho may deny the service because the facility already provided the kit. The amount of the charge will be non-covered, so the physician can bill the patient.

If the service is denied and the physician finds that the kit was not provided by the facility (such as a home birth), the physician’s office will need to send in a request for payment with the appropriate documentation showing that the kit was not provided by a facility (see PAP229).


Policy History

Date Action Reason
October 2011 Revised Language revision
May 2008 Revised Language clarification

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