BILLING NEWS

BRCA Testing

The following Texas Medicaid benefit changes have been made to support the 2012 HCPCS and CPT updates and are effective for dates of service on or after January 1, 2012.
Added
81211812128121381214812158121681217
Limitations for added procedure codes: The total laboratory component may be reimbursed to physician providers for services rendered in the office setting; to hospital providers for services rendered in the outpatient hospital setting, and to independent laboratory providers for services rendered in the independent laboratory setting.
One service per lifetime may be reimbursed with prior authorization.

Genetic Testing for Colorectal Cancer

Added
81210812758129281293812948129581296812978129881299
8130081301813178131881319
Limitations for added procedure codes: The laboratory procedure codes above may be reimbursed to indepen¨dent laboratory providers for services rendered in the independent laboratory setting. Prior authorization is required.
Procedure codes 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81317, 81318, and 81319 are limited to once per lifetime. Additional services will not be authorized.

Genetic Testing ñ Other

Added
81200
Limitations for added procedure codes: Procedure codes 82100 and S3851 will be denied if they are billed by the same provider with the same date of service.

Laboratory Services: New Molecular Pathology Procedures Tier1/Tier2 codes for 2012

Added Procedure Codes
8120081205812068120781208812098121081211 81212 81213
81214 81215 81216 81217 81220 81221 81222 81223 81224 81225
81226 81227 81228 81229 81240 81241 81242 81243 81244 81245
81250 81251 81255 81256 81257 81260 81261 81262 81263 81264
81265 81266 81267 81268 81270 81275 81280 81281 81282 81290
81291 81292 81293 81294 81295 81296 81297 81298 81299 81300
81301 81302 81303 81304 81310 81315 81316 81317 81318 81319
81330 81331 81332 81340 81341 81342 81350 81355 81370 81371
81372 81373 81374 81375 81376 81377 81378 81379 81380 81381
81382 81383 81400 81401 81402 81403 81404 81405 81406 81407
81408
Limitations for added procedure codes: The following procedure codes may be reimbursed once per lifetime:
81200 81205 81209 81211 81212 81213 81214 81215 81216 81217
81220 81221 81222 81223 81224 81225 81226 81227 81228 81229
81240 81241 81242 81243 81244 81250 81251 81255 81256 81257
81260 81265 81266 81267 81268 81270 81280 81281 81282 81290
81291 81292 81293 81294 81295 81296 81297 81298 81299 81300
81301 81302 81303 81304 81310 81317 81318 81319 81330 81331
81332 81350 81355 81370 81371 81372 81375 81378 81379
The following procedure codes may be reimbursed three per lifetime:
81206 81207 81208 81245 81261 81262 81263 81264 81315 81316
81340 81341 81342 81373 81374 81376 81377 81380 81381 81382
81383 81400 81401 81402 81403 81404 81405 81406 81407 81408

SOURCE: Source
INDUSTRY NEWS TAGS: Medicaid Texas


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