Audience: Pathology, Laboratories, Outpatient and Ambulatory Surgery Centers
Univera Healthcare is updating Administrative Policy 11 effective April 17, 2020, to define the coverage and billing guidelines for Helicobacter pylori antibody serology billed by providers contracted to provide this service. This policy is in line with Centers for Medicare & Medicaid Services, Current Procedural Terminology (CPT®), and Healthcare Common Procedure Coding System (HCPCS) guidelines. It applies to all participating practitioners and Commercial (HMO, PPO, POS, FEP, ASO/ASC and Indemnity) lines of business.
Administrative Policy 11 - Helicobacter Pylori Antibody Serology
The Health Plan will not provide reimbursement for CPT code 0008U Proprietary Laboratory Analyses services.
This policy will be reviewed pre-payment. Pre-payment review means claims are reviewed prior to payment. A pre-payment review results in an initial determination. Post-payment review means that claims are reviewed after adjudication. A post-payment review may result in either no change to the initial determination or a revised determination.
These services are subject to audit and policy updates at Univera Healthcare’s discretion. Members are held harmless for all denials resulting from this administrative policy.
You can access the individual policies on our website, UniveraHealthcare.com/Adminpol. Note: You must login with your username and password to access our administrative policies.
If you are not currently registered to view the secure section of our website, we encourage you to register today at Provider.UniveraHealthcare.com.
If you need assistance registering, contact the Web Security Help Desk at 1-800-278-1247. In addition, your Provider Relations representative is available to assist with website registration and functionality training.
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