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Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits

CR 6812, informs carriers and MACs about the new HCPCS codes for 2010 that are subject to, and those that are excluded from, CLIA edits. CLIA regulations require a facility to be appropriately certified for each test it performs; and moreover, to ensure that Medicare & Medicaid only pay for laboratory tests that are performed in certified facilities, each claim for a HCPCS code that is considered a CLIA laboratory test is currently edited at the CLIA certificate level.

HCPCS Codes Subject to CLIA Edits

The HCPCS codes listed in the following table are new for 2010 and are subject to CLIA edits:

HCPCS Description
G0430 Drug screen qualitative; multiple drug classes other than chromographic method, each procedure
G0431 Drug screen qualitative; single drug class method (e.g., immunoassay), each drug class
84145 Procalcitonin (PCT)
84431 Thromboxane metabolite(s), including thromboxane , if performed, urine
86305 Human epididymis protein 4 (HE4)
86352 Cellular function assay involving stimulation (e.g., mitogen or antigen) and detection of biomarker (e.g., APT)
86780 Antibody; Treponema pallidum
86825 Human leukocyte antigen (HLA) crossmatch, non-cytoxic (e.g., using flow cytometry); first serum sample or dilution
86826 Human leukocyte antigen (HLA) crossmatch, non-cytoxic (e.g., using flow cytometry); each additional serum sample or sample dilution (List separately in addition to primary procedure)
87150 Culture, typing; identification by nucleic acid (DNA or RNA) amplified probe technique, per culture or isolate, each organism probed
87153 Culture, typing; identification by nucleic acid sequencing method; each isolate (e.g., sequencing of 16S rRNA gene)
87493 Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile toxin gene(s), amplified probe technique
88387 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (e.g., nucleic acid-based molecular studies); each tissue preparation (e.g., a single lymph node)
88388 Macroscopic examination, dissection, and preparation of tissue for non-microscopic analytical studies (e.g., nucleic acid-based molecular studies); in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node) (list separately in addition to code for primary procedure)

Discontinued HCPCS Codes

The following HCPCS codes were discontinued on December 31, 2009:

HCPCS Description
82307 Calciferol (Vitamin D)
86781 Antibody; Treponema pallidum confirmatory test (e.g., FTA-ABS)
0087T Sperm evaluation, hyaluronan sperm binding test.

New Codes Excluded from CLIA Edits

For 2010, the following HCPCS codes are new and excluded from CLIA edits and do not require a facility to have any CLIA certificate:

HCPCS Description
83987 pH; exhaled breath condensate
88738 Hemoglobin (Hgb), quantitative, transcutaneous
89398 Unlisted reproductive medicine laboratory procedure.

Your carriers or MACs will return (as unprocessable) claims submitted for the HCPCS codes in the above table (those subject to CLIA edits), if you don’t include a CLIA number.


SOURCE: Source
INDUSTRY NEWS TAGS: CLIA


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