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

Change Request (CR) 6985, informs A/B MACs or carriers about additional new Healthcare Common Procedure Coding System (HCPCS) codes for 2010 that are subject to Clinical Laboratory Improvement Amendments (CLIA) edits.

The HCPCS codes listed in the table, below, are new for 2009 and subject to CLIA edits, and require a facility to have either:

  • A CLIA certificate of registration (certificate type code 9);
  • A CLIA certificate of compliance (certificate type code 1); or
  • A CLIA certificate of accreditation (certificate type code 3).

A facility without a valid, current, CLIA certificate, with a current CLIA certificate of waiver (certificate type code 2) or a current CLIA certificate for provider-performed microscopy procedures (certificate type code 4) cannot be paid for these tests.

HCPCS

Modifier

Description

G0416

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 1-20 specimens

G0416

TC

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 1-20 specimens

G0416

26

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 1-20 specimens

G0417

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 21-40 specimens

G0417

TC

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 21-40 specimens

G0417

26

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 21-40 specimens

G0418

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 41-60 specimens

G0418

TC

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 41-60 specimens

G0418

26

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 41-60 specimens

G0419

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, greater than 60 specimens

G0419

TC

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, greater than 60 specimens

G0419

26

Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, greater than 60 specimens


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INDUSTRY NEWS TAGS: CMS


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