Laboratory Services Performed in a Facility Setting
The established policy for reimbursement of laboratory services performed in a facility setting is consistent with the policy not to pay for duplicative laboratory services. Manual and automated laboratory services submitted by a reference or non-reference laboratory provider with a CMS facility POS 21, 22, 23, 26, 34, 51, 52, 56 or 61 will not be reimbursable. These services are reimbursable to the facility. When hospitals obtain manual or automated laboratory tests for patients under arrangements with a reference laboratory or pathology group, only the hospital can bill for the services. Note: AmeriChoice will make an exception to this policy for reproductive laboratory medicine procedures 89250-89398 when the hospital laboratory is not equipped to perform these specialized services and refers them to a reproductive laboratory. In the event that both a hospital and a reference laboratory report the same service on the same day for the same member, only the hospital reproductive laboratory services will be allowed. AmeriChoice uses the CMS National Physician Fee Schedule (NPFS) Professional Component/Technical Component (PC/TC) indicators 3 and 9 to identify laboratory services without a professional or technical component that are not reimbursable to a reference or non-reference provider in a facility setting.
• PC/TC indicator 3: Technical Component Only Codes
• PC/TC indicator 9: PC/TC Concept Not Applicable
Medicare Guideline posts
- Home
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation process - how often provide need to do - FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Subscribe to:
Post Comments (Atom)
Top Medicare billing tips
-
CPT 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a...
-
Procedure code and description 11400- Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion d...
-
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee... -
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr... -
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 - Private insurance pay upt... -
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
-
procedure code and description 11042 -Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 square cm ...
-
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
-
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
-
CPT CODE J3301 - Kenalog-40 Injection Kenalog-40 Injection (triamcinolone acetonide injectable suspension, USP) is a synthetic glucocortic...
No comments:
Post a Comment