Ocular Immunology Laboratory referral

Dear Provider:


Ocular Immunology Laboratory offers the following retinal autoantibody tests for CAR, MAR, Autoimmune Retinopathy and Optic neuropathy:

Western blot for anti-retinal autoantibodies
Western blot for anti-retinal autoantibodies in ocular fluids
Immunohistochemistry for anti-retinal autoantibodies
Western blot for anti-optic nerve autoantibodies
Western blot for anti-optic nerve autoantibodies in CSF

Since we are providing these first-of-its-kind tests, we are not billing insurance companies or carrying accounts receivable. Therefore, we are billing this service directly to providers and facilities as a Reference Lab and pre-paid purchased test only.  We have decided to follow this protocol for a couple of reasons; one, the tests are considered experimental and are likely not covered by health plans; and second, we wanted to keep costs down and the tests affordable to those who most need it. You may opt to collect reimbursement from your patient and/or their insurance as you wish. Due to the uniqueness of these tests, an Advance Beneficiary Notice of NonCoverage (ABN) is recommended. The form is available on our website.

Medicare’s instructions for submitting claims for purchased diagnostic tests are as follows:

Item 20:
Complete this item when billing for diagnostic tests subject to purchase price limitations. Enter the purchase price under charges if the "yes" block is checked. A "yes" check indicates that an entity other than the entity billing for the service performed the diagnostic test. A "no" check indicates "no purchased tests are included on the claim." When "yes" is annotated, item 32 shall be completed. When billing for multiple purchased diagnostic tests, each test shall be submitted on a separate claim Form CMS-1500. Multiple purchased tests may be submitted on the ASC X12 837 electronic format as long as appropriate line level information is submitted when services are rendered at different service facility locations. See Chapter 1 of the Medicare Claims Processing Manual.
When billing for purchased services, the technical and professional components must be billed on separate lines of the claim (i.e., you may not bill globally for a purchased service).

Our relationship as a reference lab is with you, not your patient. The results are given to you the ordering provider, not your patients.  

Thank you,

Grazyna Adamus
Professor
Ocular Immunology Laboratory