CR 11248 informs MACs about the changes to editing within the claims processing system to enforce the National Correct Coding Initiative (NCCI) coding guidance.
Effective Date: January 1, 2019
This prior logic of using ATPs and rolling up payment amounts to not exceed the panel rate, no longer exists under PAMA guidelines. HCPCS codes include those from the AMA CPT Manual, that are in the category of Organ or Disease Oriented panels, which are panels that consist of groups of specified tests. Because CMS no longer has payment logic to roll up panel pricing for organ or disease-oriented panels (also known as Automated Multi-Channel Chemistry or AMCC tests), laboratories must report the HCPCS code for the AMCC panel test where appropriate and not report separately the tests that make up that panel.
CR Transmittal Number: R4299CP