Monday, November 30, 2015

Lab Code For Drug Testing and Incorporation of Revalidation Policies



Lab codes for drug testing Issue

The 2015 Current Procedural Terminology (CPT®) codes 80100-80102 have been discontinued and replaced with CPT® 80300-80304 (presumptive drug class screening) and 80320-80377 (definitive drug testing). CPT® codes 80300-80377 have incorrectly been tagged with a procedure code status "X” (statutory exclusion), signifying that payment is not made based on the Medicare physician fee schedule database (i.e. not a physician service).

Resolution
First Coast notified the Centers for Medicare & Medicaid Services (CMS) that CPT® codes 80300-80377 have incorrectly been tagged with a procedure code status "X" (statutory exclusion). Until the status/payment indicator has been corrected, CMS has provided approval for First Coast to return claims for services billed with CPT® codes 80300-80377 to the provider.

Status/date resolved Closed/January 7, 2015

Provider action

According to the clinical laboratory fee schedule (CLFS) final determinations listed on the CMS website, providers are to use procedure codes G6030-G6058 to report these services. These procedure codes will be allowed and paid based on the CLFS. Until the status/payment indicator has been corrected, First Coast will return claims for services billed with CPT® codes 80300-80377 to the provider.

Incorporation of Revalidation Policies into Pub. 100-08, “Program Integrity Manual (PIM),” Chapter 15

This MLN Matters® Article is intended for providers and suppliers submitting claims to Medicare Administrative Contractors(MACs), including Home Health & Hospice(HH&H) MACs,for services
provided to Medicare beneficiaries.

The Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 9011 to incorporate various existing Medicare enrollment revalidation policies into Chapter 15 of the
"Program Integrity Manual" (PIM).

CR 9011 incorporates various existing revalidation policies into the PIM. As these policies were previously established via business requirements, those business requirements are not being repeated in this article. The new polices announced in CR9011 are as follows:

•When processing a voluntary termination of a reassignment, the MAC will contact the group to confirm that the group member's Provider Transaction Access Number(PTAN) is being terminated from all locations and, if multiple group member PTANs exist for multiple group locations, each PTAN is terminated.

•Many enrolled providers may actually be subparts of other enrolled providers, and some of those subparts entered their “doing business as name” as their LBN when applying for their NPIs. Once a contractor determines for certain that this situation exists, the contractor shall ask the provider to correct its NPPES information. The provider can (1) change its LBN in NPPES to read in accordance with the IRS CP-575, and (2) report its “doing business as” name in NPPES as an “Other Name”


and indicate the type of other name as a “doing business as” name.

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