CMS Updates, Clarifies Changes To Lab Test Payment

The Centers for Medicare and Medicaid Services (CMS) has revised the 2014 Clinical Laboratory Fee Schedule (CLFS) to add several codes that were inadvertently left off the previous fee schedule files and to correct a technical oversight that led to misstatement of several prices on the fee schedule. Transmittal R2916 (Change Request 8695), issued March 28, notes that existing codes have been recalculated so that their national limitation amount (NLA) and/or price for each Medicare administrative contractor (MAC) is correct. The MAC will not automatically adjust claims processed prior to implementation of the transmittal (implementation date is June 30, 2014). If a laboratory has claims that need adjustment, it should bring those claims to the MAC’s attention. Among the changes: Current Procedural Terminology (CPT) code 86152 is priced at the 2013 contractor gap-filled rate, and CPT code 86294QW is priced at 100 percent of the midpoint in the NLA pricing. Codes that have been recalculated are as follows: CPT CODE NLA CPT CODE NLA 80160 $23.48 82379 $23.01 82017 $23.01 83013 $91.89 82136 $23.01 83080 $23.01 82139 $23.01 85576 $29.31 82261 $23.01 85576QW $29.31 82270 $4.44 86355 $51.46 82271 $4.44 86357 $51.46 82271QW $4.44 86359 $51.46 82272 $4.44 86367 $51.46 […]