Idaho

OVA1 has been FDA cleared for use in women who meet specific criteria. OVA1 is not intended to be a screening test or to determine whether a patient should proceed to surgery.  It can, however, be used as a tool by the patient’s primary physician to decide if the referral for treatment of a mass should go to a gynecologist or a gyn-oncologist. Submit CPT code 84999 for OVA 1 and ROMA testing for ovarian cancer.  CGS will review the supporting documentation for individual claims to determine if the medical need is established.

The use of the term, "standing orders," in Medicare is problematic due to its diverse meanings and usages, not all of which are covered by Medicare. "Standing orders" may be understood to describe both recurring orders specific to the care of an individual patient and as routine orders for services delivered to a population of patients. Standing orders may be utilized for non-laboratory services if they met the definition of recurring orders, not routine orders. Standing orders may be used for laboratory tests ONLY if several conditions are met. Read the complete update.

Recent Comprehensive Error Rate Testing (CERT) analysis indicates increased errors when billing Prothrombin Time (PT). The PT must meet medical necessity criteria, even when done as part of a coagulation clinic or “incident to” other services.
Medicare pays for services based on medical necessity. These tests must be:

On July 21, 2010, CMS notified Noridian Administrative Services (NAS) that it would consolidate the Jurisdiction 2 and Jurisdiction 3 workloads and Medicare Administrative Contractor (MAC) contracts and issue a new request for proposal (RFP).

CMS has decided to cancel the J2 A/B MAC procurement and consolidate the J2 and J3 workloads into a new RFP that will be completed in the near future.