The frequency limit will also apply to any combination of these codes reported on the same date of service for the same member by the same provider. Unless an additional routine venipuncture/capillary blood collection is clinically necessary, the frequency limit for any of these services is once per member, per provider, per date of service. Routine Venipuncture/Capillary Blood Collection Routine venipuncture CPT codes 36415 and S9529 and capillary blood collection code 36416, are eligible for separate reimbursement when reported with an E/M and/or a laboratory service. Routine Venipuncture and the Collection of Blood Specimen from BCBSĪ. CPT 36416 will not be separately reimbursed when submitted with the following CPT codes:.CPT 36415 will not be separately reimbursed when submitted with the following CPT codes:.The most appropriate current code for G0001 is 36415 and the current fee for this is $3.00. When blood is drawn to be sent to a reference lab, use code 36415 for the venipuncture. This policy addresses the Health Plan’s reimbursement policies pertaining to clinical laboratory and related laboratory services (e.g., venipuncture and the handling and conveyance of the specimen to the laboratory) for professional provider claims submitted on a Form CMS-1500, whether performed in a provider’s office, a hospital laboratory, or an independent laboratory Please refer to the coding section of this policy for the procedure code most applicable to the method of blood withdrawal. The most common method and site of venipuncture is the insertion of a needle into the cubital vein of the anterior forearm at the elbow fold. There are several different methods for the collection of a blood sample. Venipuncture is the process of withdrawing a sample of blood for the purpose of analysis or testing. The most common method and site of venipuncture is the insertion of a needle into the cubital vein of the anterior forearm at the elbow foldĬollection of a capillary blood specimen (36416) or of venous blood from an existing access line or by venipuncture that does not require a physician’s skill or a cutdown is considered “routine venipuncture Venipuncture is the most common method used to obtain blood samples for blood or serum lab procedures, and is sometimes referred to as a “blood draw.” Venipuncture or phlebotomy is the puncture of a vein with a needle to withdraw blood. P96l5 – Catheterization for collection of specimen(s) 36415 Collection of venous blood by venipuncture – Fee schedule amount $3.10 – Private insurance pay upto $15ģ6416 Collection of capillary blood specimen (eg, finger, heel, ear stick) Fee schedule amount $3.1

What is modifier 90