In This Issue:

CMS:

• 2008 Clinical Lab Fee Schedule
• 2008 Medicare Physician Fee Schedule
• 2008 Travel Fee Schedule

California Medi-Cal:

• Procedure Code 87210 Benefit Update

Tricare:

• Procedure Codes 87620-87622 Update

Source:  Transmittal R1400CP (PDF).
Effective Date: 01/01/2008

CMS advises the following crosswalk:

New code 80047 is priced at the same rate as 80048 with final
           payment determined by the AMCC Panel Payment Algorithm;
New code 82310QW is priced at the same rate as 82310;
New code 82565QW is priced at the same rate as 82565;
New code 82610 is priced at the same rate as 83883;
New code 83655QW is priced at the same rate as 83655;
New code 83993 is priced at the same rate as 83631;
New code 84704 is priced at the same rate as 84702;
New code 86356 is priced at the same rate as 86361;
New code 87500 is priced at the same rate as 87641;
New code 87809 is priced at the same rate as 87802;
New code 89321QW is priced at the same rate as 89321;
New code 89322 is priced at the sum of the rates of 89320 and 85007;
New code 89331 is priced at the sum of the rates of 89320 and 87015; and
New AMCC code ATP23 is priced at the same rate as ATP22

You can access to the 2008 clinical laboratory fee schedule data file   here.

  New 2008 Payment Rates

Source: AMA 2008
Effective Date: 07/01/2008

The Medicare, Medicaid, and SCHIP Extension Act of 2007 made several changes affecting payments to physicians. One such change provides for a 0.5 percent increase to the physician fee schedule conversion factor for January 1 through June 30, 2008, instead of the -10.1 percent that was scheduled to take place. As of July 1, 2008, the -10.1 percent update to the physician fee schedule will go into effect.

Source:  Transmittal R1400CP (PDF).
Effective Date: 01/01/2008

Travel allowance to collect a specimen from a nursing home or homebound patient will also remain at the 2007 rates in 2008. For dates of service January 01, 2008 through December 31, 2008, the fee for clinical laboratory travel code P9603 is $0.935 per mile and for code P9604 is $9.35 per flat rate trip basis.

Additionally, XIFIN has updated their Medicare Travel Allowance Calculation Guide, a tool that may be helpful to you in estimating potential travel reimbursements.

Source:  General Medicine Medi–Cal Update December 2007 | Bulletin 402 (PDF).

Effective for dates of service on or after January 1, 2008, procedure code 87210 (smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]), when billed with modifier QW, is no longer a benefit of the Medi-Cal program. Claims billing 87210 with the QW modifier will be denied.

  HPV Test Covered Only With Abnormal Pap Smear

Source: TriWest Healthcare Alliance.

The human papillomavirus virus (HPV) test (CPT procedure codes 87620-87622) is covered by TRICARE only when performed after an abnormal Pap smear, i.e., for the assessment of women with atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous itraepithelial (LSIL) cells.

The HPV test is not covered when performed as a screening test simultaneously with a regular Pap smear, e.g., if you indicate on your claim that the HPV test was included in the screening as “standard practice,” the claim will be denied. Remember to send the test to a network laboratory.

For further information, refer to the TRICARE Policy Manual, Chapter 6, Section 1.1 at www.tricare.mil, www.triwest.com or call 1-888-TRIWEST (888-874-9378).