Lab Resources April 03, 2006

April 03, 2006

CLIA Waived Tests

CMS

Transmittal: R872CP (PDF).
Publication Date: February 24, 2006
Implementation Date: April 03, 2006

The following are the latest tests approved by the FDA as waived CLIA tests. The CPT codes for the following new tests must have the modifier QW to be recognized as a waived test.

CPT Code / Modifier	Effective Date	Description
86318QW	09/27/05	Instant Technologies iScreen H.pylori Rapid Test Device
82465QW 83718QW	09/27/05	Polymer Technology Systems Cardiochek PA Analyzer (PTS Panels CHOL+HDL Test Panel Test Strips)
86308QW	10/07/05	Instant Technologies iScreen Mononucleosis Rapid Test Device {Whole Blood}
86308QW	10/07/05	Instant Technologies iScreen Mononucleosis Rapid Test Strip {Whole Blood}
87807QW	10/20/05	Fisher Scientific Sure-Vue RSV Test
87807QW	10/20/05	SA Scientific SAS RSV Alert
87804QW	11/23/05	SA Scientific SAS Influenza A Test
87804QW	11/23/05	SA Scientific SAS Influenza B Test

Denial of Claims Not Timely Filed

CMS

Medicare Matters: MM4041 (PDF).
Publication Date: February 02, 2006
Implementation Date: July 03, 2006

CR4041 clarifies that a determination relating to the untimely submission of a Medicare claim by a provider or supplier is not an initial determination and cannot be appealed.

Claims that are filed after the “timely filing period” will be denied as specified in the Medicare Claims Processing Manual, Publication 100-4, Chapter 1, Section 70.1. When a claim is denied because it was filed after the timely filing period, the denial will not constitute an “initial determination.” As such, the determination that a claim was not filed timely cannot be appealed.

Additional information can be found at: R830CP (PDF).

Repeat Tests for Automated Multi-Channel Chemistries for End Stage Renal Disease Beneficiaries

CMS

Medicare Matters: MM4101 (PDF).
Publication Date: October 28, 2005
Implementation Date: April 03, 2006

Clinical diagnostic laboratory tests ordered by an ESRD facility must follow CPT guidelines. Specifically, Modifier 91 must be used on any subsequent service being billed if 1) any single service (same CPT code) is ordered (for the same beneficiary), and 2) the specimen is collected more than once in a single day, and the service is medically necessary. Also, any line item on a claim with a modifier 91 will be included into the calculation of the 50/50 rule, and after the calculation of the 50/50 rule, services used to determine the payment amount may never exceed 22.

NCD Update

CMS

Medicare Matters: MM4328 (PDF).
Publication Date: February 17, 2006
Effective Date: April 01, 2006

The following changes in laboratory NCD code are included in the release for clinical diagnostic laboratory services. Several of the listed changes correct codes to reflect the current CPT update.

Blood Count NCD

Add ICD-9-CM V76.51 Special screening for malignant neoplasms, colon to the list of codes that do not support medical necessity for the Blood Count NCD

ICD-9-CM Codes Never Covered by Medicare

Delete ICD-9-CM V76.51 Special screening for malignant neoplasms, colon from the list of ICD-9-CM codes never covered by Medicare

Fecal Occult Blood Test NCD

Add the following new CPT 82272 Blood occult peroxidase to the list of HCPCS/CPT codes covered by Medicare for Fecal Occult Blood Test NCD

Delete CPT 82270 Fecal occult blood from the HCPCS/CPT code list for Fecal Occult Blood Test NCD

Hepatitis Panel/Acute Hepatitis Panel NCD

Add ICD-9-CM 790.4 Nonspecific Elevation of Levels of Transaminase or Lactic Acid Dehydrogenase to the list of ICD-9-CM codes covered by Medicare for Hepatitis Panel/Acute Hepatitis Panel NCD

Lipids Testing NCD

Add new CPT codes 83700 Lipoprotein bld, electrophoretic and 83701 Lipoprotein bld, hr fraction to the list of HCPCS/CPT codes covered by Medicare for Lipids Testing NCD

Delete CPT Codes 83715 Lipoprotein, blood: electrophoretic separation and quantitation and 83716 High resolution fractionation and quantitation of lipoprotein cholesterols from the HCPCS/CPT code list for Lipids Testing NC

Urine Culture, Bacterial NCD

Delete Coding Guideline 1 in the Urine Culture, Bacterial NCD, and renumber the remaining Coding Guidelines

Medicare to Stop Providing Paper Remittance

CMS

Medicare Matters: SE0611 (PDF).
Publication Date: March 09, 2006
Effective Date: June 01, 2006

Paper remittances received through the mail will no longer be available to providers who receive an ERA (Electronic Remittance Advice). CMS has developed free software called Medicare Remit Easy Print (MREP) that gives providers a tool to read and print a remittance advice (RA) from the HIPAA compliant Remittance advice (835) file.

Those providers who are currently receiving the ERA, who would like to continue to have access to paper remittance, should begin using MREP software before the June 1st cutoff. Further information is available from: MREP Software.

Eliminating Use of Surrogate UPINs Rescinded

CMS

Transmittal: 752 (PDF).
Publication Date: November 10, 2005

CR4177 Rescinded

Eliminating the Use of Surrogate UPINs is rescinded.

CMS will replace CR 4177 in the near future with CR5019.

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