Billing News May 2005



Children's Treatment Program - Eligibility and Claim Submission

  • May 2, 2005

Medi-Cal has issued a claim submission reminder to providers submitting for Children's Treatment Program (CTP). The claim must include a valid recipient identification number, Benefits Identification Card (BIC) and Client Identification Number or Social Security Number. The PM 160 form must be attached.

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Draft LCD for Allergy Testing

  • May 2, 2005

NHIC will implement the new draft LCD for 86003 Allergen Specific IGE; Quantitative or OR Semiquantiative, each allergen and 86005 Allergen Specific IGE; Qualitative, Multiallergen Screen (dipstick, paddle or disk).

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Travel Fee Update

  • May 2, 2005

Part B travel allowance for 2005 is increased to $0.855 per mile (HCPCS code P9603) and $8.55 per flat rate trip basis (P9604), under a correction announced by Medicare and retroactive to January 01. Medicare contractors aren't required to adjust travel fees already paid, but must do so for claims that clinical laboratories bring to...

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Reflexed Manual Differentials

  • May 2, 2005

At the April 25, 2005 Lab Open Door Forum CMS noted that the following guidance in the current National Correct Coding Policy Manual, Chap. 10, Pathology/Laboratory Services essentially prohibits billing for a reflexed manual WBC differential performed as a result of an abnormal or flagged automated WBC differential. "If, after a test is...

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Matching Claims Data to Beneficiary Records

  • May 2, 2005

Revision to the Centers for Medicare...

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National Provider Identifier

  • May 2, 2005

CMS announced the implementation of enumeration for the National Provider Identifier (NPI). The NPI is the standard unique health identifier for health care providers that was adopted by the Secretary of Health and Human Services under the Health Insurance Portability and Accountability Act of 1996. CMS’s announcement letter informs health care...

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NCD Edits

  • May 2, 2005

CMS has released the July 2005 update to its Medicare National Coverage Determinations (NCDs) Manual for Clinical Diagnostic Laboratory Services. This update revises a number of the lab NCDs include: Thyroid Testing: 84436, 84439, 84443, 84479 added ICD-9 code 733.02 Tumor Antigen by Immunoassay CA 19-9: 86301 added...

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QW Modifier

  • May 2, 2005

Providers possessing a Clinical Laboratory Improvement Amendments (CLIA) Certificate of Wavier or Provider - Performed Microscopy Procedures (PPMP) must utilize a test kit and bill the program utilizing a QW modifier with for the following codes: 80061, 80101, 81003, 81007,82010, 82044, 82055, 82120, 82273, 82274, 82465, 82523, 82570, 82679, 82947...

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