Billing News Sep 2010



COLA (Formerly the Commission on Office Laboratory Accreditation) Voluntary Withdrawal From the Specialty of Pathology

  • September 2, 2010

In a letter dated June 15, 2010, COLA provided official notice of its intent to voluntarily withdraw from accreditation in the specialty of Pathology. This withdrawal was effective June 30, 2010. All laboratories accredited by COLA in the specialty of Pathology (to include Histopathology, Oral Pathology or Cytology) will have 60 days from the date...

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Medi-Cal Provider Payments During Period Without State Budget

  • September 2, 2010

The State of California does not have an enacted fiscal year (FY) 2010-11 budget. The Department of Health Care Services (DHCS) directed the fiscal intermediary, HP Enterprise Services, to continue to pay Medi-Cal non-institutional providers per federal mandate and continue to pay Medi-Cal institutional providers from the Medical Providers...

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Save Time with eTARs for MRI

  • September 2, 2010

The Department of Health Care Services (DHCS) recommends that providers begin using the electronic Treatment Authorization Request (eTAR) system to submit TARs for Magnetic Resonance Imaging (MRI). Provider should click the Transactions tab on the Medi-Cal Web site and log in using a National Provider Identifier (NPI) and PIN. They should then...

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H1N1 Testing: New Benefit

  • September 2, 2010

Retroactive for dates of service on or after July 24, 2009, H1N1 testing using real-time RT-PCR assay is now a Medi-Cal benefit. Testing is allowed for H1N1 using two units of CPT code 87798 (infectious agent detected by nucleic acid [DNA], amplified probe technique) when billed with ICD-9-CM diagnosis code 488.1 and modifier 59 (distinct...

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Initial Trofile Test Update

  • September 2, 2010

The Pathology: Microbiology section of the Part 2 provider manual was updated with new guidelines for providers billing an initial test with Trofile using CPT-4 code 87999 (unlisted microbiology procedure). The new guidelines state that the indication for a Trofile test is based on Guidelines for the Use of Anti-retroviral Agents In HIV-1...

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Documentation Not Required for HIV Drug Resistance Testing Codes

  • September 2, 2010

Effective for dates of service on or after September 1, 2010, drug resistance testing CPT codes 87901 (infectious agent genotype analysis by nucleic acid; HIV-1, reverse transcriptase and protease), 87903 (infectious agent phenotype analysis by nucleic acid with drug resistance tissue culture analysis) and 87904 (infectious agent phenotype...

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Presumptive Eligibility (PE) Program for Pregnant Women: New Lab Benefits

  • September 2, 2010

Effective for dates of service on or after September 1, 2010, HCPCS Level II laboratory procedure codes G0430 (drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure) and G0431 (drug screen, qualitative; single drug class method [eg., immunoassay, enzyme assay], each drug class) will become benefits for...

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New Tools Added to Secure Provider Portal

  • September 2, 2010

TriWest Healthcare Alliance (TriWest) continues to enhance its offerings to registered users on the secure provider portal. Effective July 14, 2010, TriWest deployed a new reporting tool to assist providers in performing TriWest claims reconciliation and status determination. The Provider Claims Report is available to all users...

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