Medicare & Medicaid
MPLN bills Medicare through Cahaba government services in Tennessee and Trailblazer Health Enterprises of Virginia. We accept Medicare's allowed rates as 100% of payment. If Medicare pays only a co-insurance amount of the allowed Medicare rate, or if the patient's deductible is not met, then the patient is responsible for the difference.
MPLN accepts the Medicaid allowed rate as full payment. We are enrolled or applying for enrollment with: Alabama, Arizona. Florida, Georgia, Indiana, Kentucky, North Carolina, Ohio, Maryland, Missouri, Mississippi, Pennsylvania, South Carolina, Tennessee, Utah, Virginia, Washington.
CMS: Clinical laboratory fee schedule
CPT Codes
The Current Procedural Terminology (CPT) Codes that MPLN provides are based on our interpretation of CPT code requirements and are subject to review and change. It is our clients' responsibility to verify the accuracy of the codes listed and assign value based on reimbursement for your area. If you have questions about usage of CPT codes, contact your Medicare carrier.
AMA CPT codes
Medical Necessity
Medical necessity guidelines are provided by Centers for Medicare & Medicaid (CMS). MPLN encourages clients to utilize an Advanced Beneficiary Notice (ABN) on any laboratory procedure that Medicare may not deem as medically necessary. Without a signed ABN on file, MPLN reserves the right to bill the client for any tests deemed not medically necessary.
Click below for Local Coverage Determination (LCD):
LCD listing by CMS
LCD listing by Trailblazer Health Enterprises for Virginia
If you have any questions, please contact the billing department at 800.600.1274.
Billing Forms
Advanced Beneficiary Notice Form
Advanced Beneficiary Notice Instructions
