J1 Part B Medical Review Service Specific Probe Review of Laboratory Services

The J1 Medical Review Department will be performing service specific pre-pay probe reviews of laboratory services in the three Jurisdiction 1 regions: Northern California, Southern California and Nevada/Hawaii.

These reviews will focus on laboratory codes 80101, 80102, 80154, 80299, 82306, 83898, 83925, 86706 and 88319.

80101 Drug screen, qualitative; single drug class method, each drug class

80102 Drug confirmation, each procedure

 80154 Benzodiazepines

 80299 Quantitation of drug, not elsewhere specified

 82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed

 83898 Molecular diagnostics; amplification, target, each nucleic acid sequence

 83925 Opiate(s), drug and metabolites, each procedure

 86706 Hepatitis B surface antibody (HBsAb)

 88319 Determinative histochemistry or cytochemistry to identify enzyme constituents, each

The determination of need for review is based on Global Data Analysis which demonstrates increased utilization of these services. A sample of 100 claims for each of codes 82306, 83898 and 86706 will be selected for review from Northern California. In Southern California, a sample of 100 claims will be selected for each of codes 80101, 80102, 80154, 80299, 82306, 83925 and 88319. In the Nevada/Hawaii region, a sample of 100 claims for code 80101 will be selected.