Update Regarding the Technical Component (TC) of Pathology Services Furnished to Hospital Patients/ASC

This Change Request communicates revisions to the Medicare Claims Processing Manual (Chapter 12 and Chapter 16) so that billing and claims processing instructions contained within are up-to-date with regards to billing for the TC of physician pathology services furnished to hospital patients. For services furnished on or after July 1, 2012, an independent laboratory may not bill the Medicare contractor (and the Medicare contractor may not pay) for the TC of a physician pathology service furnished to a hospital inpatient or outpatient. Payment is not made under the physician fee schedule for TC services furnished in institutional settings, e.g., hospital inpatient and outpatient settings, where the TC service is bundled into the facility payment.

CMS is clarifying the policy to indicate that payment is made under the physician fee schedule for TC services furnished in institutional settings, e.g., an ambulatory surgery center (ASC), where the TC service is not bundled into the facility payment.