Clinical Laboratory Fee Schedule Not Otherwise Classified, Not Otherwise Specified or Unlisted Service or Procedure Code Data Collection

Change Request (CR) 10232 instructs MACs to assure that providers submit private payor data on unique tests currently being paid as a Not Otherwise Classified (NOC) code, Not Otherwise Specified (NOS) code, or Unlisted Service or Procedure code. PAMA requires reporting entities to report private payor payment rates for laboratory tests and the corresponding volumes of tests. In compliance with PAMA, CMS must collect private payor data on unique tests currently being paid as a Not Otherwise Classified (NOC) code, Not Otherwise Specified (NOS) code, or Unlisted Service or Procedure code. In compliance with PAMA, CMS is collecting private payor data on unique tests currently being paid as a NOC code, NOS code, or unlisted service or procedure code. The update of the “Medicare Claims Processing Manual,” Chapter 26, “Completing and Processing Form CMS-1500 Data Set,” clarifies how providers of service or suppliers should populate field 19 of the form when billing NOC codes. Specifically, when billing for unlisted laboratory tests using a NOC code, field 19 must be populated with the specific name of the laboratory test(s) and/or a short descriptor of the test(s).

*The policy appears to be in conflict with PAMA data submission guidelines promulgated by CMS which excluded reporting  NOC codes”.  XiFin and other entities are seeking clarification.

Source: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2017Downloads/R3881CP.pdf