After claims from the Government Accountability Office (GAO) in November of 2018 that labs unbundling automated chemistry test claims will correlate to a drastic increase in Medicare spending, many industry thought leaders are responding. Most recently, ACLA has released a statement claiming that GAO’s assumptions are not backed by Medicare’s public claims data, or by ACLA’s own survey conducted with its members. According to the survey, “less than .003 percent of claims were submitted with individual test codes when all tests in a panel were performed, rather than with that appropriate panel codes.”1
While ACLA agrees with CMS that panel tests with billing codes should be paid at the panel code rate, they point out that the American Medical Association (ACA) CPT guidelines, which regulate this issue, have not changed.
“PAMA’s Implementation had no impact whatsoever on CPT coding Guidelines”1
ACLA is firmly supporting CMS’s efforts to make sure labs are submitting claims in accordance with these long-standing coding regulations. However, the organization wants to make sure it is known that GAO may have pointed out a potential issue, but has not identified a current widespread problem.
For more information on ACLA’s stance on this issue, check out the full statement.