Venipuncture: Not Covered by This Payer (Facility Setting)

Procedure Code:

  • CPT code 36415

Denial Reason, Reason/Remark Code(s)

  • CO-109: Claim is not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

Resolution/Resources

  • Venipuncture is not covered under Part B in a facility setting. These charges are part of the hospital's bill to Medicare (Part A). Facility settings include the following places of service:
    • 19: off campus outpatient hospital
    • 21: inpatient hospital
    • 22: on campus outpatient hospital
    • 23: emergency room- hospital
    • 51: inpatient psychiatric facility
    • 52: psychiatric facility partial hospitalization
    • 61: comprehensive inpatient rehabilitation facility
    • 62: comprehensive outpatient rehabilitation facility
    • Do not submit Part B claims for venipuncture performed in these settings to Palmetto GBA

Contact Palmetto GBA JM Part B Medicare

Email Part B

Contact a specific JM Part B department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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