These documents and the information contained herein is for general information purposes only and is not intended, and does not constitute, legal reimbursement, business, clinical or other advice. Furthermore, it does not constitute a representation or guarantee of reimbursement, and it is not intended to increase or maximize payment by any payer. Nothing in this document should be construed as a guarantee by bioMérieux regarding reimbursement or payment amounts, or that reimbursement or other payment will be received. bioMérieux specifically disclaims liability or responsibility and offers no guarantee of coverage, coding, or payment and specifically disclaims liability or responsibility for coding practices of healthcare providers. The customer is solely responsible for determining appropriate charging and billing practices, as well as accurate coding, documentation, and medical necessity for the services provided. This includes the responsibility for accuracy and veracity of all claims submitted to third-party payers. In addition, the customer should note that laws, regulations, and coverage policies are complex and are updated frequently, and, therefore, the customer should check with its local carriers or intermediaries often and should consult with legal counsel or a financial or reimbursement specialist for any questions related to billing, reimbursement, or any related issue. This information does not guarantee coverage or payment at any specific level and bioMérieux does not advocate or warrant the appropriateness of the use of any particular code. It is not provided or authorized for marketing use.
Coding and Billing FAQ
The following are commonly asked questions regarding billing and coding along with the respective answers.
- Where can I find coding information of the BIOFIRE Panels?
- Information about our panels as well as basic coverage and potential coding information can be found below under Health Program Guides
- Where can I find the reimbursement amounts for BIOFIRE Panels?
- Reimbursement amounts are often contract specific and may vary. While Medicare’s Clinical Laboratory Fee Schedule (CLFS) is public information and may be found on the CMS website, other payer fee schedules may not be publicly available. You can contact your contracted payer directly to verify contracted rates.
- Will I be guaranteed reimbursement if the correct code is used?
- The existence of codes does not guarantee coverage or payment for any procedure by any payer. The healthcare provider is solely responsible for determining the appropriate coverage, coding and payment policies for individual patients.
- What is CodeMap®?
- CodeMap® is a third-party company providing information on Medicare coverage, as well as some state Medicaid information for BIOFIRE Panels. The link to this information is below under CodeMap®
- Does CodeMap® provide information regarding commercial insurance payers?
- The information listed on CodeMap® is public information available from public sources. It does not provide information specific to commercial or private payers.
- Is there an extra cost to use CodeMap®?
- Information on CodeMap® is complimentary and for educational purposes only.
- What do I do if my claim is denied?
- There are many reasons why a claim might be denied. It’s best to reach out to your Billing or Managed Care departments, or you can contact the payer directly to figure out the denial reason and next steps and appealing if needed.
- Do you help with appealing denied claims?
- Claim appeal letter templates are available below, under Claim Appeal Letters.
Health Program Guides
Health Program & Insurance Guides provide general information to providers that bill public and private payers for services. They include information specific to each of the panels offered by bioMérieux, including descriptions of the panel, CPT code(s) that may describe the test, and other information. Click the appropriate link below to download the Health Program & Insurance Guide that corresponds to the panel of interest.
Note: Health Program & Insurance Guides are dated and updated as needed.
CodeMap® is a third-party vendor that provides additional information for providers. It is specific to government healthcare programs, including Medicare and State Medicaid plans and is provided for educational purposes. By clicking the link below, you will be taken to the CodeMap® website and can find additional information for our panels.
Claim Appeal Letters
Click the appropriate link below to download the Claim Appeal Letter that corresponds to the panel of interest.