04/04/2017

Denials for CPT Code 87116

We would like to bill 87116 Mycobacteria culture, but it is getting denied as not covered what other code can I use.

CPT 87116 is being denied by the insurance carriers for two reasons:

• The service is usually performed to test for tuberculosis or leprosy
• Coverage for this CPT is usually performed in a lab within a hospital and freestanding facility and is typically not performed by podiatrists

If it does seem medically necessary for the test to be performed, it would be advised to refer the patient to a lab accepted by their insurance for the test. This lab service would be outside the scope of services that a podiatry practice may provide and few, if any payers, would cover the service.