Manual Update to Include Billing Instructions for Professional Component (PC) and Technical Component (TC) in Regards to One Line Global Billing for Pathology Services

CMS is providing clarification regarding global billing for TC and PC with different dates of service (DOS). When the TC and PC of pathology services are performed on different DOS bill them as separate line items even if they are performed by the same independent laboratory. Global billing is not appropriate for this instance.

CMS revised the DOS policy for clinical laboratory tests and added the technical component of physician pathology service effective January 1, 2009.

The DOS policy for either a clinical laboratory test or the technical component of physician pathology service is as follows:

• General Rule: The DOS of the test/service must be the date the specimen was collected.
• Variation: If a specimen is collected over a period that spans two calendar days, then the DOS must be the date the collection ended.

The following two exceptions apply to this DOS policy for either a clinical laboratory test or the technical component of physician pathology service:

• Provider Payments During Period of No State Budget
• DOS for Tests/Services Performed on Stored Specimens
• DOS for Chemotherapy Sensitivity Tests/Services Performed on Live Tissue

When the TC and PC of pathology services are performed on different Date of Service (DOS), they shall be billed as separate line items if the services are performed by the same independent laboratory.