Technical Component Of Anatomical Pathology

CMS CR 8013 effective for services furnished July 1, 2012, and after rescinded the previous instruction on billing for the technical component of anatomical pathology for hospital patients. The technical component is not billed separately to Medicare Part B, but instead is submitted to the facility for inclusion in the facility’s charge to Medicare. Providers can continue to submit the professional component of the anatomical pathology to Medicare Part B. 

CMS CR 8399 effective date of processing January 1, 2014, and after provides an exception to the information in CR 8013. Providers can bill the technical component to Medicare Part B when the patient was not an inpatient or outpatient at the time of the service necessitating the anatomical pathology. In order for Medicare to make payment, the claims history file must include a charge from the same physician who ordered the anatomical pathology service and that service must show the physician performed the service in a non-hospital place of service (i.e., the place of service is not 21 or 22). Providers can investigate the circumstances to verify the same physician who ordered the service is also the same physician who provided the service necessitating the anatomical pathology and verify where the service was performed. If the service was performed by the physician in an inpatient or outpatient setting, then the technical component should be submitted back to the facility for payment. If the service was performed in a nonhospital setting, then the provider can request an appeal. Instructions are on the WPS website concerning how to request an appeal. Providers can use spreadsheets when they have many claims to reopen.

WPS Medicare MAC J5 for Iowa, Kansas, Missouri, and Nebraska and MAC J8 for Indiana and Michigan