Lab Resources April 22, 2008

May 1, 2008

In This Issue:

Medicaid:
California - Medi-Cal

Pathology Codes Reminder
Trofile is a New Medi-Cal Benefit
AmniSure Test Not a Medi-Cal Benefit
CPT-4 Codes 80061 and 83721 Billing and Reimbursement Update
Billing Requirement Update for CPT-4 code 88141
Family PACT Billing Update for CPT-4 Code 88141
Reminder: End-Dating of Medi-Cal Provider Numbers

CMS

CMS-CR 5913: New CLIA Waived Tests
RARC and CARC Update
Collapsing Medicare Provider Transaction Access Numbers (PTANs) to Ensure a One-to-One National Provider Identifier (NPI) Match
Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits
REVISED ABN NOTICE
Clinical Laboratory Fee Schedule - Implementation of Section 113 Medicare, Medicaid and State Children’s Health Insurance Program (MMSCHIP) Legislation

Pathology Codes Reminder

California - Medi-Cal

February 2008 | Bulletin 404

Providers are reminded that retroactively effective for dates of service on or after September 1, 2006, CPT-4 code 87900 (infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics) is not separately reimbursable with codes 87903 (infectious agent phenotype analysis by nucleic acid, [DNA or RNA] with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested) and 87904 (each additional drug tested).

Trofile is a New Medi-Cal Benefit

California - Medi-Cal

March 2008 | Bulletin 405

Retroactive to dates of service on or after September 4, 2007, the Trofile test is a Medi-Cal benefit and can be billed using CPT-4 code 87999 (unlisted microbiology procedure). Current Medi-Cal reimbursement for this code is “By Report.”

This blood test is available for recipients with diagnosed Acquired Immune Deficiency Syndrome (AIDS) who have evidence of viral replication and HIV-1 strain resistance to multiple anti-retroviral agents. This test will help determine if the recipient will respond to a new class of drugs, classified as CCR-5 antagonists.

This test is to be performed only once in the recipient’s lifetime. Providers must document on the claim that the recipient has evidence of anti-retroviral drug resistance intolerance and a lack of patient acceptability to reasonable alternative anti-retroviral drug regimens resulting in inability to fully suppress HIV. Failure to provide such documentation will result in denial of the claim.

AmniSure Test Not a Medi-Cal Benefit

California - Medi-Cal

March 2008 | Bulletin 405

Providers are reminded that the AmniSure test for detecting amniotic fluid in female recipients is not a Medi-Cal benefit. Providers may not bill for this test using any CPT-4 80000 series laboratory procedure codes, including CPT-4 codes 83518 (immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; single step method [eg, reagent strip]) and 84999 (unlisted chemistry procedure).

CPT-4 Codes 80061 and 83721 Billing and Reimbursement Update

California - Medi-Cal

April 2008 | Bulletin 406

Effective for dates of service on or after May 1, 2008, CPT-4 codes 80061 (lipid panel test) and 83721 (LDL cholesterol test) may not both be reimbursed on the same date of service, for the same recipient, and by the same rendering provider unless the triglyceride level of the recipient is greater than 400 mg/dl.

This triglyceride level value must be entered in the Remarks field (Box 80)/Reserved for Local Use field ( Box 19) of the claim form. In addition, both CPT-4 codes must be billed on the same claim form in order for providers to receive reimbursement for codes 80061 and 83721 on the same date of service. If the triglyceride level of the recipient is less than 400 mg/dl and both CPT-4 codes 80061 and 83721 are billed on the same date of service, for the same recipient, and by the same rendering provider, only code 80061 will be reimbursed.

Billing Requirement Update for CPT-4 code 88141

California - Medi-Cal

April 2008 | Bulletin 406

Effective on or after May 1, 2008, reporting for CPT-4 code 88141 (cytopathology, cervical, or vaginal [any reporting system] requiring interpretation by physician) has been updated. A pathology report is no longer required. Claims billing CPT-4 code 88141 may now be reimbursed if the patient has recently had an abnormal Papanicolaou smear and the claim is billed with ICD-9-CM diagnosis codes 795.0 – 795.09. Failure to document one of these ICD-9-CM diagnosis codes will result in denial of the claim.

Family PACT Billing Update for CPT-4 Code 88141

California - Medi-Cal

April 2008 | Bulletin 406

Effective for dates of service on or after May 1, 2008, claims billed with CPT-4 Code 88141 (cytopathology, cervical, or vaginal [any reporting system] requiring interpretation by physician) no longer require a pathology report copy for manual review, and may now be reimbursed when billed with a primary and secondary diagnosis code.

Providers should submit claims for code 88141 using a primary diagnosis S-code and a secondary ICD-9-CM diagnosis code within the range of 795.0 – 795.09. Claims will be denied unless they include both an acceptable S-code in the primary diagnosis field and a valid secondary diagnosis code.

Reminder: End-Dating of Medi-Cal Provider Numbers

California - Medi-Cal

April 2008 | Bulletin 406

Providers are reminded that once a claim is submitted with a National Provider Identifier (NPI), the associated Medi-Cal “legacy” provider number(s) will be end-dated. In other words, effective for dates of service beyond the date of a claim submitted with an NPI, the Medi-Cal provider number will no longer be valid.

Using the associated Medi-Cal provider number(s) following a claim submission with an NPI will result in claim denials for subsequent dates of service. Once providers begin using their NPI on claim submissions, they are strongly encouraged to continue using the NPI to prevent claim payment interruption.

New CLIA Waived Tests

CMS

MLN Matters: MM5913

Effective Date: April 1, 2008

Implementation Date: April 7, 2008

New waived tests and their effective dates. The CPT codes for these tests must have the QW modifier to be recognized as a waived test.

CPT Code	Effective Date	Description
87880QW	June 25, 2007	PSS World Medical Select Diagnostics Strep A Dipstick
86308QW	July 12, 2007	Signify Mono Cassette {Whole Blood}
86308QW	July 12, 2007	Poly Stat Mono Test {Whole Blood}
86308QW	July 12, 2007	Clearview MONO Whole Blood, K042272/A016
86318QW	July 25, 2007	Polymedco Poly Stat H. Pylori Test (Whole Blood)
86318QW	July 25, 2007	Henry Schein One Step+ H. Pylori Rapid Test Device (Whole Blood)
87880QW	August 14, 2007	Medical The Supply Experts Strep A Rapid Test – Dipstick
87880QW	August 21, 2007	Jant Pharmacal Accustrip Strep A Value+ Test Strip
87880QW	August 21, 2007	Abbott Laboratories Signify Strep A Dipstick
86318QW	September 11, 2007	Abbott Laboratories Signify H. Pylori Cassette {Whole Blood}
82465QW, 83718QW, 82947QW, 82950QW, 82951QW, 82952QW	September 21, 2007	Polymer Technology Systems CardioChek PA Analyzer (PTS Panels CHOL+HDL+GLUC Panel Test Strips)
82465QW, 83718QW, 82947QW, 82950QW, 82951QW, 82952QW	September 21, 2007	Polymer Technology Systems CardioChek Brand Analyzer (PTS Panels CHOL+HDL+GLUC Panel Test Strips)
85014QW	September 21, 2007	Abbott i-STAT Chem8+ Cartridge {Whole Blood}
82465QW, 83718QW	October 15, 2007	Polymer Technology Systems CardioChek PA Analyzer (PTS Panels CHOL+HDL Panel Test Strips)
82465QW, 83718QW	October 15, 2007	Polymer Technology Systems CardioChek Brand Analyzer (PTS Panels CHOL+HDL Panel Test Strips)
82565QW, 84520QW	October 18, 2007	Abaxis Piccolo xpress Chemistry Analyzer (Kidney Check Panel){Whole Blood}
86703QW	October 22, 2007	Clearview Complete HIV 1/2 {Fingerstick Venipuncture, whole blood}

CPT Code	Effective Date	Description
80051QW	October 30, 2007	Abaxis Piccolo Blood Chemistry Analyzer (Electrolyte Metabolic Reagent Disc){Whole Blood}
80051QW	October 30, 2007	Abaxis Piccolo xpress Chemistry Analyzer (Electrolyte Metabolic Reagent Disc){Whole Blood}
87804QW	November 1, 2007	BinaxNOW Influenza A & B Test {Nasopharyngeal (Np) Swab and Nasal Wash/Aspirate Specimens and Nasal Swabs (NS)}
80101QW	December 13, 2007	Quest Diagnostics Incorporated, Express Results Integrated Multi-Drug Screen Cup {professional use}
80047QW	January 1, 2008	Abbott i-STAT Chem8+ Cartridge {Whole Blood}
80048QW	January 16, 2008	Abaxis Piccolo Blood Chemistry Analyzer (Basic Metabolic Reagent Disc){Whole Blood}
80048QW	January 16, 2008	Abaxis Piccolo xpress Chemistry Analyzer (Basic Metabolic Reagent Disc){Whole Blood}
80053QW	January 16, 2008	Abaxis Piccolo Blood Chemistry Analyzer (Comprehensive Metabolic Reagent Disc){Whole Blood}
80053QW	January 16, 2008	Abaxis Piccolo xpress Chemistry Analyzer (Comprehensive Metabolic Reagent Disc){Whole Blood}

The following CPT codes do not require the QW modifier in order to be recognized as waived tests:

CPT Code	Description
81002	Dipstick or tablet reagent urinalysis – non-automated for bilirubin, glucose, hemoglobin, ketone, leukocytes, nitrite, pH, protein, specific gravity, and urobilinogen
81025	Urine pregnancy tests by visual color comparison
82270, 82272, G0394 (Contact your Medicare carrier or A/B MAC for claims instructions.)	Fecal occult blood
82962	Blood glucose by glucose monitoring devices cleared by the FDA for home use
83026	Hemoglobin by copper sulfate – non-automated

84830	Ovulation tests by visual color comparison for human luteinizing hormone
85013	Blood count;spun microhematocrit
85651	Erythrocyte sedimentation rate-non-automated

RARC and CARC Update

CMS

MLN Matters: MM5942

Effective Date: April 1, 2008

Code	Current Narrative	Medicare Initiated
N430	Procedure code is inconsistent with the units billed. Start: 11/5/2007 Note: (New Code 11/5/07)	YES
N431	Service is not covered with this procedure. Start: 11/5/2007 Note: (New Code 11/5/07)	YES
N432	Adjustment based on a Recovery Audit. Start: 11/5/2007 Note: (New Code 11/5/07)	YES

Modified Codes

Code	Current Modified Narrative	Last Modification Date
M25	The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request a appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.	11/5/2007

Code	Modified Narrative	Implementation Date
M26	The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service /any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice. The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.	11/5/2007
M75	Multiple automated multichannel tests performed on the same day combined for payment.	11/5/2007
M112	Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.	11/5/2007
M113	Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.	11/5/2007
M114	This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.	11/5/2007
M115	This item is denied when provided to this patient by a non-contract or non-demonstration supplier.	11/5/2007
N70	Consolidated billing and payment applies.	11/5/2007

Code	Modified Narrative	Implementation Date
N367	Alert: The claim information has been forwarded to a Consumer Account Fund processor for review.	11/5/2007
N377	Payment based on a processed replacement claim.	11/5/2007
N385	Notification of admission was not timely according to published plan procedures.	11/5/2007

Deactivated Codes

Code	Current Narrative	Modification Date
MA119	Provider level adjustment for late claim filing applies to this claim. Start: 1/1/1997 \| Stop: 5/1/2008 \| Last Modified: 11/5/2007 Note: (Deactivated eff. 5/1/08) Consider using Reason Code B4.)	Deactivated eff. 5/1/08

Claim Adjustment Reason Codes

New Codes

Code	Current Narrative	Implementation Date
212	Administrative surcharges are not covered Start: 11/05/2007	11/05/2007

Modified Codes

Code	Modified Narrative	Implementation Date
121	Indemnification adjustment - compensation for outstanding member responsibility. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
192	Non standard adjustment code from paper remittance. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment. Start: 10/31/2005 \| Last Modified: 09/30/2007	4/1/2008
206	National Provider Identifier - missing. Start: 07/09/2007 \| Last Modified: 09/30/2007	4/1/2008
207	National Provider identifier - Invalid format Start: 07/09/2007 \| Stop: 05/23/2008 \| Last Modified: 09/30/2007	4/1/2008
208	National Provider Identifier - Not matched. Start: 07/09/2007 \| Last Modified: 09/30/2007	4/1/2008
15	The authorization number is missing, invalid, or does not apply to the billed services or provider. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
17	Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
19	This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008

Code	Modified Narrative	Implementation Date
20	This injury/illness is covered by the liability carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
21	This injury/illness is the liability of the no-fault carrier. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
22	This care may be covered by another payer per coordination of benefits. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
23	The impact of prior payer(s) adjudication including payments and/or adjustments. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
24	Charges are covered under a capitation agreement/managed care plan. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
31	Patient cannot be identified as our insured. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
33	Insured has no dependent coverage. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
34	Insured has no coverage for newborns. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
55	Procedure/treatment is deemed experimental/investigational by the payer. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
56	Procedure/treatment has not been deemed `proven to be effective' by the payer. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
58	Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
59	Processed based on multiple or concurrent procedure rules. (For example multiple surgery or	4/1/2008

Code	Modified Narrative	Implementation Date
diagnostic imaging, concurrent anesthesia.) Start: 01/01/1995 \| Last Modified: 09/30/2007
61	Penalty for failure to obtain second surgical opinion. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
95	Plan procedures not followed. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
97	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
107	The related or qualifying claim/service was not identified on this claim. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
108	Rent/purchase guidelines were not met. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
112	Service not furnished directly to the patient and/or not documented. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
115	Procedure postponed, canceled, or delayed. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
116	The advance indemnification notice signed by the patient did not comply with requirements. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
117	Transportation is only covered to the closest facility that can provide the necessary care. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
118	ESRD network support adjustment. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
125	Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP	4/1/2008

Code	Modified Narrative	Implementation Date
Reject Reason Code.) Start: 01/01/1995 \| Last Modified: 09/30/2007
129	Prior processing information appears incorrect. Start: 02/28/1997 \| Last Modified: 09/30/2007	4/1/2008
135	Interim bills cannot be processed. Start: 10/31/1998 \| Last Modified: 09/30/2007	4/1/2008
136	Failure to follow prior payer’s coverage rules. (Use Group Code OA). Start: 10/31/1998 \| Last Modified: 09/30/2007	4/1/2008
137	Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. Start: 02/28/1999 \| Last Modified: 09/30/2007	4/1/2008
138	Appeal procedures not followed or time limits not met. Start: 06/30/1999 \| Last Modified: 09/30/2007	4/1/2008
141	Claim spans eligible and ineligible periods of coverage. Start: 06/30/1999 \| Last Modified: 09/30/2007	4/1/2008
142	Monthly Medicaid patient liability amount. Start: 06/30/2000 \| Last Modified: 09/30/2007	4/1/2008
146	Diagnosis was invalid for the date(s) of service reported. Start: 06/30/2002 \| Last Modified: 09/30/2007	4/1/2008
148	Information from another provider was not provided or was insufficient/incomplete. Start: 06/30/2002 \| Last Modified: 09/30/2007	4/1/2008
150	Payer deems the information submitted does not support this level of service. Start: 10/31/2002 \| Last Modified: 09/30/2007	4/1/2008

Code	Modified Narrative	Implementation Date
151	Payer deems the information submitted does not support this many services. Start: 10/31/2002 \| Last Modified: 09/30/2007	4/1/2008
152	Payer deems the information submitted does not support this length of service. Start: 10/31/2002 \| Last Modified: 09/30/2007	4/1/2008
153	Payer deems the information submitted does not support this dosage. Start: 10/31/2002 \| Last Modified: 09/30/2007	4/1/2008
154	Payer deems the information submitted does not support this day's supply. Start: 10/31/2002 \| Last Modified: 09/30/2007	4/1/2008
155	Patient refused the service/procedure. Start: 06/30/2003 \| Last Modified: 09/30/2007	4/1/2008
157	Service/procedure was provided as a result of an act of war. Start: 09/30/2003 \| Last Modified: 09/30/2007	4/1/2008
158	Service/procedure was provided outside of the United States. Start: 09/30/2003 \| Last Modified: 09/30/2007	4/1/2008
159	Service/procedure was provided as a result of terrorism. Start: 09/30/2003 \| Last Modified: 09/30/2007	4/1/2008
160	Injury/illness was the result of an activity that is a benefit exclusion. Start: 09/30/2003 \| Last Modified: 09/30/2007	4/1/2008
163	Attachment referenced on the claim was not received. Start: 06/30/2004 \| Last Modified: 09/30/2007	4/1/2008
164	Attachment referenced on the claim was not received in a timely fashion.	4/1/2008

Code	Modified Narrative	Implementation Date
Start: 06/30/2004 \| Last Modified: 09/30/2007
165	Referral absent or exceeded. Start: 10/31/2004 \| Last Modified: 09/30/2007	4/1/2008
168	Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
169	Alternate benefit has been provided. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
173	Service was not prescribed by a physician. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
174	Service was not prescribed prior to delivery. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
175	Prescription is incomplete. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
176	Prescription is not current. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
177	Patient has not met the required eligibility requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
178	Patient has not met the required spend down requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
179	Patient has not met the required waiting requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
180	Patient has not met the required residency requirements. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008

Code	Modified Narrative	Implementation Date
181	Procedure code was invalid on the date of service. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
182	Procedure modifier was invalid on the date of service. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
186	Level of care change adjustment. Start: 06/30/2005 \| Last Modified: 09/30/2007	4/1/2008
191	Not a work related injury/illness and thus not the liability of the workers’ compensation carrier. Start: 10/31/2005 \| Last Modified: 09/30/2007	4/1/2008
194	Anesthesia performed by the operating physician, the assistant surgeon or the attending physician. Start: 02/28/2006 \| Last Modified: 09/30/2007	4/1/2008
195	Refund issued to an erroneous priority payer for this claim/service. Start: 02/28/2006 \| Last Modified: 09/30/2007	4/1/2008
197	Precertification/authorization/notification absent. Start: 10/31/2006 \| Last Modified: 09/30/2007	4/1/2008
198	Precertification/authorization exceeded. Start: 10/31/2006 \| Last Modified: 09/30/2007	4/1/2008
202	Precertification/authorization exceeded. Start: 10/31/2006 \| Last Modified: 09/30/2007	4/1/2008
203	Discontinued or reduced service. Start: 02/28/2007 \| Last Modified: 09/30/2007	4/1/2008
A8	Ungroupable DRG. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
B5	Coverage/program guidelines were not met or were exceeded. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008

Code	Modified Narrative	Implementation Date
B8	Alternative services were available, and should have been utilized. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
B9	Patient is enrolled in a Hospice. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
B14	Only one visit or consultation per physician per day is covered. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
B15	This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
B16	`New Patient' qualifications were not met. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
B18	This procedure code and modifier were invalid on the date of service. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
B20	Procedure/service was partially or fully furnished by another provider. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008
B23	Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. Start: 01/01/1995 \| Last Modified: 09/30/2007	4/1/2008

Deactivated Codes

Code	Current Narrative	Implementation Date
25	Payment denied. Your Stop loss deductible has not been met. Start: 01/01/1995 \| Stop: 04/01/2008	4/1/2008
126	Deductible -- Major Medical Start: 02/28/1997 \| Stop: 04/01/2008 \| Last Modified: 09/30/2007 Notes: Use Group Code PR and code 1.	4/1/2008
127	Coinsurance -- Major Medical Start: 02/28/1997 \| Stop: 04/01/2008 \| Last Modified: 09/30/2007 Notes: Use Group Code PR and code 2.	4/1/2008
145	Premium payment withholding Start: 06/30/2002 \| Stop: 04/01/2008 \| Last Modified: 09/30/2007 Notes: Use Group Code CO and code 45.	4/1/2008
A4	Medicare Claim PPS Capital Day Outlier Amount. Start: 01/01/1995 \| Stop: 04/01/2008 \| Last Modified: 09/30/2007	4/1/2008

Collapsing Medicare Provider Transaction Access Numbers (PTANs) to Ensure a One-to-One National Provider Identifier (NPI) Match

CMS

MLN Matters: MM5906

Effective Date: January 1, 2008

Implementation Date: April 7, 2008

CMS issued CR 5906 because it believes that providers may want to collapse their assigned Medicare PTANs to insure a one-to-one NPI match. Providers may collapse PTANs that are assigned to additional locations only if the additional locations are all assigned the same tax identification number (TIN) and are within the same pricing locality.

Presently, some Medicare carriers issue separate PTANs to physicians with multiple practice locations. To ensure that carriers are assigning PTANs in a more consistent manner and to aid in the implementation of the NPI, carriers and A/B MACs will assign the minimum number of PTANs necessary to ensure that proper payments are made.

Providers can request their carrier or A/B MAC collapse their PTANs by submitting a letter on their letterhead to the Medicare contractor. The letter must contain:

The TIN of the provider/entity and/or the Social Security Number of the individual(s);
The effective date for the collapsed PTANs; and
A signature of the authorized official making the request.

Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

CMS

MLN Matters: MM5926

Effective Date: January 1, 2008

Implementation Date: April 7, 2008

CR 5926 informs carriers and A/B MACS about the new HCPCS codes for 2008 that are subject to CLIA edits and also about those that are now excluded from CLIA edits.

The HCPCS codes listed in the chart that follows are new for 2008 and are subject to CLIA edits.

HCPCS Code	Description
80047	Basic metabolic panel (Calcium, ionized)
82610	Cystatin C
83993	Calprotectin, fecal
84704	Gonadotropin, chorionic (hCG); free beta chain
86356	Mononuclear cell antigen, quantitative (eg, flow cytometry), not otherwise specified, each antigen
87500	Infectious agent detection by nucleic acid (DNA or RNA); vancomycin resistance (eg, enterococcus species van A, van B), amplified probe technique
87809	Infectious agent antigen detection by immunoassay with direct optical observation; adenovirus
88381	Microdissection (ie, sample preparation of microscopically identified target); manual
89322	Semen analysis; volume, count, motility, and differential using strict morphologic criteria (eg, Kruger)
89331	Sperm evaluation, for retrograde ejaculation, urine (sperm concentration, motility, and morphology, as indicated)

The HCPCS code 86586 [Unlisted antigen, each] was discontinued on 12/31/2007.
For 2008, the new HCPCS code 86486 [Skin test; unlisted antigen, each] is excluded from CLIA edits and does not require a facility to have any CLIA certificate.

REVISED ABN NOTICE

CMS

Effective Date: September 1, 2008

Implementation Date: March 3, 2008

On Monday, March 3, 2008, CMS will implement use of the revised Advance Beneficiary Notice of Noncoverage (ABN) (CMS-R-131).

This form replaces the General Use ABN (CMS-R-131-G), and the Lab ABN (CMS-R-131-L) for physician ordered laboratory tests. The form and notice instructions will be posted on the Beneficiary Notice Initiative web page (http://www.cms.hhs.gov/BNI/02_ABNGABNL.asp#TopOfPage). Updated manual instructions and the Spanish version of the form on the BNI web page will be posted in the near future.

Some key features of the new form are that it:

Has a new official title, the “Advance Beneficiary Notice of Noncoverage (ABN)”, in order to more clearly convey the purpose of the notice;
Replaces both the existing ABN-G and ABN-L;
May also be used for voluntary notifications, in place of the Notice of Exclusion from Medicare Benefits (NEMB);
Has a mandatory field for cost estimates of the items/services at issue; and
Includes a new beneficiary option, under which an individual may choose to receive an item/service, and pay for it out-of-pocket, rather than have a claim submitted to Medicare.

CMS will allow a 6-month transition period from the date of implementation for use of the revised form and instructions. Thus, all providers and suppliers must begin using the new ABN (CMS-R-131) no later than September 1, 2008. Questions about the new ABN may be sent to RevisedABN_ODF@cms.hhs.gov

Clinical Laboratory Fee Schedule - Implementation of Section 113 Medicare, Medicaid and State Children’s Health Insurance Program (MMSCHIP) Legislation

CMS

MLN Matters: MM5987

Effective Date: April 1, 2008

Implementation Date: May 12, 2008

Change Request (CR) 5987 alerts clinical laboratories that, effective for tests furnished on or after April 1, 2008, the MMSCHIP Extension Act of 2007 sets payment for code 83037 and 83037QW (Hemoglobin; glycosylated (A1c) by device) by crosswalking it to be the same as 83036 (glycosylated (A1c)). The payment be the same as the payment on the clinical laboratory fee schedule for 83036.

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