While a procedure code may be listed on the fee schedule, all codes are subject to plan policies and provisions, including clinical editing and medical necessity guidelines. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement.
Venipuncture (36415) is not covered separately when lab work has also been performed and billed by the provider. For lab tests requiring routine venipuncture and subsequently sent to an outside lab, the physician office can bill either the venipuncture service or the handling charge, but not both. These services may be denied as incidental, or included in a primary service when billed in conjunction with another service.
If further clarification is needed, please contact the claims administrator toll-free 800-323-4314.