4th Quarter Lab/Radiology Reimbursement policy updates

Policy Implementation Date What’s Changed
Laboratory Rebundling Policy - changes relating to surgical pathology consultation codes reported with evaluation and management services Effective Fourth Quarter 2011 The Pathology Consultation section of this policy will be revised to add surgical pathology consultation codes 88321, 88323 and 88325 to the codes treated as included in an Evaluation and Management (E/M) code reported by the same pathologist or reference laboratory on the same date of service. Accordingly, consistent with CMS, separate reimbursement for these codes will be denied and no modifier override will be allowed.
Contrast and Radiopharmaceutical Materials Policy Effective Fourth Quarter 2011 The Contrast and Radiopharmaceutical Materials Policy will be revised to add CPTÆ codes 64479, 64483, 64490, 64493, 22556, 62263, and 62264 to the list of eligible procedures that allow for separate reimbursement of contrast and radiopharmaceutical materials (HCPCS codes A4641, A4642, A9500-A9700, J1245, Q3001, Q9951, Q9953, Q9954 and Q9956- Q9968) in a non-facility setting. Under the current policy, reimbursement for these materials used in providing these non-imaging procedures is denied because the fluoroscopic guidance (CPTÆ codes 77001, 77002, and 77003) is included in the code descriptions for these procedures.

Published by XIFIN
INDUSTRY NEWS TAGS: United Healthcare

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