Billing Beat

Electronic Submission of Laboratory Services with Medical Justification

August 2, 2004

Effective for dates of service on or after September 1, 2004, providers may electronically bill for laboratory services (CPT-4 80000 series codes and HCPCS Level III codes) that require medical justification by entering the medical justification in the electronic filing Remarks area of the transaction. Medical justification statements entered in the electronic filing Remarks area must not exceed 1,500 characters. If the statement exceeds the character limit, providers must submit a paper claim with the appropriate medical justification documents accompanying the claim. Claims and “By Report” attachments for the following CPT-4 and HCPCS codes may not be submitted electronically:

CPT-4 / HCPCS Codes Description
83013 Helicobacter pylori; analysis for urease activity, non-radioactive isotope
83014 drug administration and sample collection
87620 Papillomavirus, human, direct probe technique
87621 amplified probe technique
87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV 1, reverse transcriptase and protease
87902 Hepatitis C virus
87903 Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested
87904 each additional 1 through 5 drugs tested
Z2004 Surgical pathology, gross and microscopic examination of presumptively normal tissue(s) obtained in conjunction with abortion procedure

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