BILLING NEWS

Re-implementation of the AMCC Lab Panel Claims Payment System Logic

Implementation Date: October 7, 2019, 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.

Note the following:

  • If you perform HCPCS codes 82040, 84075, 84450, 84460, 82247, 82248 AND 84155 for the same date of service (DOS), do not report them separately. Report organ disease panel code 80076 instead.
  • If you perform codes 82330, 82435, 82374, 82565, 82947, 84132, 84295 AND 84520 for the same DOS. Report organ disease panel code 80047 instead.
  • If you perform codes 82310, 82435, 82374, 82565, 82947, 84132, 84295 AND 84520 for the same DOS. Report organ disease panel code 80048 instead.
  • If you perform codes 82040, 84075, 84450, 84460, 82247, 82310, 82435, 82374, 82565, 82947, 84132, 84155, 84295 AND 84520 for the same DOS. Report organ disease panel code 80053 instead.
  • If you perform codes 82040, 82310, 82435, 82374, 82565, 82947, 84100, 84132, 84295 AND 84520 for the same DOS. Report organ disease panel code 80069 instead.
  • If you perform codes 82465, 83718 AND 84478 for the same DOS. Report organ disease panel code 80061 instead.
  • If you perform codes 82435, 82374, 84132 AND 84295 for the same DOS. Report organ disease panel code 80051 instead.
  • CR: 11248, Transmittal: R4299CP

INDUSTRY NEWS TAGS: CMS


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