Saturday, August 14, 2010

Medicare lab CPT code with covered diagnosis

Laboratory National Coverage Determinations included for Laboratory Customers



CPT Policy Number Title Original Effective Date Last Revised
80061 190.23 Lipids Testing 11/25/2002 10/1/2009
80074 190.33 Hepatitis Panel/Acute Hepatitis Panel 11/25/2002 10/1/2009
80162 190.24 Digoxin Therapeutic Drug Assay 11/25/2002 10/1/2009
82105 190.25 Alpha-fetoprotein 11/25/2002 10/1/2009
82270 190.34 Fecal Occult Blood Test 11/25/2002 7/1/2008
82272 190.34 Fecal Occult Blood Test 11/25/2002 10/1/2009
82378 190.26 Carcinoembryonic Antigen 11/25/2002 10/1/2009
82465 190.23 Lipids Testing 11/25/2002 10/1/2009
82523 190.19 Collagen Crosslinks, Any Method 11/25/2002
82728 190.18 Serum Iron Studies 11/25/2002 1/1/2010
82947 190.2 Blood Glucose Testing 11/25/2002 4/1/2009
82948 190.2 Blood Glucose Testing 11/25/2002 4/1/2009
82962 190.2 Blood Glucose Testing 11/25/2002 4/1/2009
82977 190.32 Gamma Glutamyl Transferase 11/25/2002 1/1/2010
82985 190.21 Glycated Hemoglobin/Glycated Protein 11/25/2002 1/1/2009
83036 190.21 Glycated Hemoglobin/Glycated Protein 11/25/2002 1/1/2009
83540 190.18 Serum Iron Studies 11/25/2002 1/1/2010
83550 190.18 Serum Iron Studies 11/25/2002 1/1/2010
83700 190.23 Lipids Testing 11/25/2002 10/1/2009
83701 190.23 Lipids Testing 11/25/2002 10/1/2009
83704 190.23 Lipids Testing 11/25/2002 10/1/2009
83718 190.23 Lipids Testing 11/25/2002 10/1/2009
83721 190.23 Lipids Testing 11/25/2002 10/1/2009
84153 190.31 Prostate Specific Antigen 11/25/2002 10/1/2008
84436 190.22 Thyroid Testing 11/25/2002 10/1/2009
84439 190.22 Thyroid Testing 11/25/2002 10/1/2009
84443 190.22 Thyroid Testing 11/25/2002 10/1/2009
84466 190.18 Serum Iron Studies 11/25/2002 1/1/2010
84478 190.23 Lipids Testing 11/25/2002 10/1/2009
84479 190.22 Thyroid Testing 11/25/2002 10/1/2009
84702 190.27 Human Chorionic Gonadotropin 11/25/2002 1/1/2007
85004 190.15 Blood Counts 11/25/2002 7/1/2008
85007 190.15 Blood Counts 11/25/2002 7/1/2008
85008 190.15 Blood Counts 11/25/2002 7/1/2008
85013 190.15 Blood Counts 11/25/2002 7/1/2008
85014 190.15 Blood Counts 11/25/2002 7/1/2008
85018 190.15 Blood Counts 11/25/2002 7/1/2008
85025 190.15 Blood Counts 11/25/2002 7/1/2008
85027 190.15 Blood Counts 11/25/2002 7/1/2008
85032 190.15 Blood Counts 11/25/2002 7/1/2008
85048 190.15 Blood Counts 11/25/2002 7/1/2008
85049 190.15 Blood Counts 11/25/2002 7/1/2008
85610 190.17 Prothrombin Time (PT) 11/25/2002 10/1/2009
85730 190.16 Partial Thromboplastin Time (PTT) 11/25/2002 10/1/2009
86300 190.29 Tumor Antigen by Immunoassay CA 15-3/CA 27.29 11/25/2002 10/1/2006
86301 190.3 Tumor Antigen by Immunoassay CA 19-9 11/25/2002 10/1/2006
86304 190.28 Tumor Antigen by Immunoassay CA 125 11/25/2002 10/10/2006
86689 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
86701 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
86702 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
86703 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87086 190.12 Urine Culture, Bacterial 11/25/2002 10/1/2009
87088 190.12 Urine Culture, Bacterial 11/25/2002 10/1/2009
87390 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87391 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87534 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87535 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87536 190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) 11/25/2002 10/1/2008
87537 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87538 190.14 Human Immunodeficiency Virus (HIV) Testing (Diagnosis) 11/25/2002 1/1/2009
87539 190.13 Human Immunodeficiency Virus (HIV) Testing (Prognosis Including Monitoring) 11/25/2002 10/1/2008
G0103 210.1 Prostate Cancer Screening Tests 11/25/2002
G0123 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002
G0124 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0141 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0143 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0144 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0145 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0147 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0148 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
G0248 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management 11/25/2002 3/19/2008
G0249 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management 11/25/2002 3/19/2008
G0250 190.11 Home Prothrombin Time INR Monitoring for Anticoagulation Management 11/25/2002 3/19/2008
G0328 210.3 Colorectal Cancer Screening Tests 11/25/2002
P3000 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
P3001 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
Q0091 210.2 Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal Cancer 11/25/2002 4/1/2007
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download