IHCP to allow outpatient reimbursement for certain lab CPT codes

Effective August 21, 2015, the Indiana Health Coverage Programs (IHCP) will allow reimbursement of the following CPT codes in the outpatient setting when they are billed with appropriate revenue codes on a UB-04 claim form.

• 88333 Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site
• 88360 Microscopic genetic analysis of tumor
• 88367 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; using computer-assisted technology
• 88368 Morphometric analysis, in situ hybridization (quantitative or semi-quantitative) each probe; manual

This change applies retroactively to fee-for-service claims with dates of service on or after July 1, 2015. Beginning August 21, 2015, claims with these CPT codes with DOS on or after July 1, 2015 may be submitted with a revenue code, as appropriate, for reimbursement consideration. Claims for these codes with DOS on or after July 1, 2015 that previously denied for explanation of benefits (EOB) 6000 – Manual pricing required may be resubmitted. Claims filed beyond the original one-year filing limit must include a copy of this banner page as an attachment and must be filed within one year of the publication date.