Billing News Jan 2019



LSA 18-375 Radiology Rule

  • January 8, 2019

Amends 405 IAC 5-27-1 to update definitions and terminology. Amends 405 IAC 5-27-2 to clarify prior authorization and service limitations for radiologic procedures. Amends 405 IAC 5-27-3 to update definitions and terminology and revise Medicaid policy for computerized tomography scans. Amends 405 IAC 5-27-6 to update terminology and revise...

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Calendar Year (CY) 2019 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment

  • January 8, 2019

CR 11076 provides instructions for the Calendar Year (CY) 2019 Clinical Laboratory Fee Schedule (CLFS), mapping for new codes for clinical laboratory tests, and updates for laboratory costs subject to the reasonable charge payment. Next CLFS Data Collection Period Revisions to the Definition of Applicable Laboratory Coding for Health Common...

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MolDX Local Coverage Determination (LCD) Updates

  • January 8, 2019

The MolDX: HLA-B*15:02 Genetic Testing L36033 A/B MAC LCD was revised. Revision Effective Date For services performed on or after 12/06/2018 Added B20 in the ICD-10 Group 1 List as a covered code. The addition of B20 is retro-effective to 2/26/18.

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MolDX Local Coverage Determination (LCD) Updates

  • January 8, 2019

The following A/B MAC LCDs were revised: MolDX: Molecular Diagnostic Tests – L35025 MolDX: BRCA1 and BRCA2 Genetic Testing – L36082 MolDX: Breast Cancer Index℠ Genetic Assay – L35631 MolDX: CYP2C19, CYP2D6, CYP2C9, and VKORC1 Genetic Testing – L35072 MolDX: MGMT Promoter Methylation Analysis – L35974 Lab: Controlled Substance Monitoring...

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Breast Cancer Molecular Tests Included in Recommendations by UK’s NICE

  • January 8, 2019

The UK's National Institute for Health and Care Excellence (NICE) has included three molecular diagnostics — Myriad Genetics' EndoPredict, NanoString's Prosigna, and Genomic Health's Oncotype DX — in recommendations for tests guiding chemotherapy decisions for early-stage breast cancer patients.

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SABCS 2018 Features Molecular Diagnostics Research

  • January 8, 2019

At the San Antonio Breast Cancer Symposium last week, researchers presented data from many studies exploring the use of molecular technologies to make patient care more precise. They included studies exploring the ability of breast cancer recurrence molecular diagnostics to predict which patients are likely to experience a relapse and benefit...

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Medicare Program: Clinical Laboratory Improvement Amendments (CLIA) of 1988 Fees (CMS-3356-NC)

  • January 8, 2019

The fact sheet discusses why CMS is increasing the CLIA fees for the first time in 20 years.  Based on the agency’s financial data review, they project that a 20 percent fee increase will sustain and maintain the CLIA program through FY 2021.  CMS is required to update the program’s fee schedule because current fees are no longer...

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MolDX: Cystatin C Measurement Final LCD - Effective February 11, 2019

  • January 8, 2019

Medicare Coverage Database (MCD) Number/Contractor Determination Number: L37618 LCD Title: MolDX: Cystatin C Measurement Effective Date: February 11, 2019 Summary of LCD: Cystatin C is a low molecular weight protein produced by all nucleated cells in the body at a constant rate. It has been proposed and investigated as an improved marker of renal...

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