Prenatal Cystic Fibrosis Screening Update for May 2009

Effective retroactively for dates of service on or after February 1, 2009, providers billing for cystic fibrosis laboratory tests (CPT-4 codes 83890 - 83914) may bill these codes in any combination, for any quantity, up to a maximum reimbursement of $180, once in a lifetime per recipient.

Due to a claims processing system correction that will take place in April 2009, providers should hold all cystic fibrosis claims until May 1, 2009. Any claims that were erroneously denied due to an invalid modifier, with dates of service from February 1, 2009 through April 30, 2009, will be automatically reprocessed for reimbursement.

In addition, the following conditions apply:

  • When codes 83890 - 83914 are used to bill for the purpose of cystic fibrosis screening tests, ICD-9-CM code V26.31 (testing of female for genetic disease carrier status) or code V26.34 (testing of male for genetic disease carrier status) is required.
  • Codes 83890 - 83914 must be billed with modifier 8A (genetic cystic fibrosis) when a potential carrier is tested for cystic fibrosis. When multiple modifiers are required, providers should not bill modifier 99. Instead, they should bill 8A in the second, third or fourth modifier position. If 8A is the only modifier billed, then providers should bill it in the first modifier position.
  • The maximum reimbursement for any combination of the above codes remains $180.
  • The appropriate Clinical Laboratory Improvement Amendments (CLIA) certification is required to perform cystic fibrosis laboratory testing. If the cystic fibrosis test is sent to an outside lab, then providers should bill modifier 90 in the first modifier position.

SOURCE: Source
INDUSTRY NEWS TAGS: California Medi-Cal

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