Rate Updates for BRCA Testing Procedure Codes

Reimbursement rates for clinical laboratory or laboratory services may not exceed 80 percent of the lowest maximum allowance established by the Medicare program for the same or similar services. Rates for CPT codes 81211, 81212, 81213, 81215 and 81217 for BRCA testing will be updated to comply with the statutory rate for clinical laboratory services. The rates will be effective retroactively for dates of service on or after January 1, 2014. No action is required on your part. An Erroneous Payment Correction (EPC) will occur for claims adjudicated prior to the system update for dates of service on or after January 1, 2014.

Source: General Medicine | March 2014 | Bulletin 477