This article is based on CR 8695 which provides instructions for the revised CY 2014 clinical laboratory fee schedule, including several codes that were inadvertently left off of the previous CY 2014 fee schedule files. These codes, which were intended to be included on the original CY 2014 clinical laboratory fee schedule file, were recently given a “QW” modifier to both identify the codes and to determine payment for tests performed by a laboratory having only a certificate of waiver under CLIA. Also, CR8695 corrects a technical oversight that led to the misstatement of several prices on the fee schedule. Those prices reflected on this file created for CR8695 are now correct.
Existing codes that have been recalculated so that their national limitation amount (NLA) and/or price for each MAC is correct. These codes are 80160, 82017, 82136, 82139,82261, 82270, 82271, 82271QW, 82272, 82272QW, 82274, 82274QW, 82379, 83013, 83080, 85576, 85576QW, 86355, 86357, 86359, 86367, G0123, G0328, and G0328QW.
Existing Code Pricing
• Existing code 86152 is priced at the 2013 contractor gap filled rate.
• Existing code 86294QW is priced at 100 percent of the midpoint in the NLA pricing.
Note that your MAC will not automatically adjust claims processed prior to implementation of CR8695. However, if you have claims that need adjustment, your MAC will adjust those claims that you bring to their attention.