Independent Laboratory Billing of Automated Multi-Channel Chemistry (AMCC) Organ Disease Panel Laboratory Tests for Beneficiaries who are not Receiving Dialysis for Treatment of End Stage Renal Disease (ESRD)
INDUSTRY NEWS TAGS: CMS
Prior to January 2011, Independent Labs were paid according to the 50/50 rule payment calculation for AMCC laboratory tests provided to beneficiaries who were eligible for Medicare under the ESRD benefit. Additionally, under the 50/50 rule, Independent Labs were not allowed to bill organ disease panel codes because of the 50/50 rule payment calculation.
Effective for services on or after January 1, 2012, your Medicare contractor(s) will:
• Allow organ disease panel codes (i.e., HCPCS codes 80047, 80048, 80051, 80053, 80061, 80069, and 80076) to be billed by Independent Labs for ESRD eligible beneficiaries when the beneficiary is not receiving dialysis treatment for any reason (e.g., post-transplant beneficiaries); and
• Make payment for organ disease panels according to the Clinical Laboratory Fee Schedule and apply the normal ESRD PPS editing rules for IL claims.