Updates for Chlamydia Trachomatis and Neisseria Gonorrhoeae

Effective for dates of service on or after April 1, 2014, the Family PACT Program will require an additional diagnostic restriction for CPT code 87491 (Chlamydia trachomatis, amplified probe technique) and CPT code 87591 (Neisseria gonorrhoeae, amplified probe technique) testing on Family PACT claims unless otherwise noted. ICD-9-CM codes corresponding to risk factors include V01.6, V02.8, V69.2, V12.09, V73.88 and V74.5. For Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) tests to be reimbursed, the ordering provider must indicate the medical necessity for the test with the appropriate ICD-9-CM code on the laboratory order. The laboratory provider must include the additional ICD-9-CM diagnosis code on the claim form along with the family planning diagnosis code. Additionally, CPT code 87081 (culture, presumptive, pathogenic organisms, screening only) will no longer be allowed for GC screening.