Medicare Lab Fee Schedule for 2014: New CPT Codes and Payment Method Recommendations
MEDICARE LAB FEE SCHEDULE FOR 2014: NEW CPT CODES AND PAYMENT METHOD RECOMMENDATIONS CODE DESCRIPTOR CODE CROSSWAK OR GAP-FILL PROPOSED NLA Therapeutic Drug Assays 80XXX1 Caffeine AACC: Crosswalk to 80198 ACLA, ASCP, CAP: Crosswalk to 82491 $19.45 $24.82 80XXX2 Clozapine AACC, ACLA, ASCP, CAP: Crosswalk to 80154 $25.43 80XXX3 Everolimus AACC: Crosswalk to 80158 ACLA, […]
| MEDICARE LAB FEE SCHEDULE FOR 2014: NEW CPT CODES AND PAYMENT METHOD RECOMMENDATIONS | ||
| CODE DESCRIPTOR | CODE CROSSWAK OR GAP-FILL | PROPOSED NLA |
| Therapeutic Drug Assays | ||
| 80XXX1 Caffeine | AACC: Crosswalk to 80198 ACLA, ASCP, CAP: Crosswalk to 82491 | $19.45 $24.82 |
| 80XXX2 Clozapine | AACC, ACLA, ASCP, CAP: Crosswalk to 80154 | $25.43 |
| 80XXX3 Everolimus | AACC: Crosswalk to 80158 ACLA, ASCP, CAP: Crosswalk to 82542 | $24.81 $24.82 |
| 80XXX4 Gabapentin | AACC: Crosswalk to 80157 ACLA, ASCP, CAP: Crosswalk to 82491 | $20.02 $24.82 |
| 80XX5 Lamotrigine | AACC: Crosswalk to 80157 ACLA, ASCP, CAP: Crosswalk to 82542 | $20.02 $24.82 |
| 80XXX6 Levetiracetam | AACC: Crosswalk to 80157 ACLA, ASCP, CAP: Crosswalk to 82542 | $20.02 $24.82 |
| 80XX5 Lamotrigine | AACC: Crosswalk to 80157 ACLA, ASCP, CAP: Crosswalk to 82542 | $20.02 $24.82 |
| 80XXX7 Mycophenolate | AACC: Crosswalk to 80158 ACLA, ASCP, CAP: Crosswalk to 82542 | $24.81 $24.82 |
| 80XXX8 Oxcarbazepine | AACC: Crosswalk to 80157 ACLA, ASCP, CAP: Crosswalk to 82542 | $20.02 $24.82 |
| 80XXX9 Tiagabine | AACC: Crosswalk to 80157 ACLA, ASCP, CAP: Crosswalk to 82542 | $20.02 $24.82 |
| 80XX10 Zonisamide | AACC: Crosswalk to 80157 ACLA, ASCP, CAP: Crosswalk to 82542 | $20.02 $24.82 |
| TIER 1 MOLECULAR PATHOLOGY PROCEDURES | ||
| 81161 DUPLICATION/DELETION ANALYSIS | AACC: Crosswalk to 81404 ACLA: Take the median of the code stacks which were used to bill this test prior to the adoption of the Tier 1 Molecular Pathology Codes ASCP, CAP: Crosswalk to 81407 | |
| 812XX MGMT (O6-methylguanine DNA methyltransferase) | AACC: Crosswalk to 81404 ACLA: Take the median of the code stacks which were used to bill this test prior to the adoption of the Tier 1 Molecular Pathology Codes ASCP, CAP: Crosswalk to 81401 | |
| MULTIANALYTE ASSAYS WITH ALGORITHMIC ANALYSES | ||
| 0004M SCOLIOSIS 53 SNP SALIVA SCOR | AACC: Crosswalk to 81408 ACLA, ASCP: Administrative MAAA CPTs are not assigned an NLA | |
| 0005M FETAL ANEUPLOIDY TRISOM RISK | AACC: Crosswalk to 81404 ACLA, ASCP: Administrative MAAA CPTs are not assigned an NLA This code is scheduled for deletion effective Jan. 1, 2014 | |
| 815XX1 Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes | AACC: No comment as this procedure is not commercially available ACLA, ASCP: No comment as this procedure is not currently available CAP: No comment | |
| 81508 FTL CGEN ABNOR TWO PROTEINS | AACC, ACLA, ASCP: Crosswalk to 84163 + 84702 $41.40 | |
| MICROBIOLOGY | ||
| 8766X1 Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique | AACC, ACLA, ASCP, CAP: Crosswalk to 87511 | $48.24 |
| RECONSIDERATION REQUESTS | ||
| 0001M INFECTIOUS DIS HCV 6 ASSAYS | AACC: Crosswalk to 84460 + 83520 + 82172 + 82247 + 82977 + 83010 ACLA: Administrative MAAA CPTs are not assigned an NLA ASCP: ASCP is not offering recommendations for this code, as it is an administrative MAAA code that is not intended to be on a fee schedule CAP: No comment | $80.46 |
| 0002M LIVER DIS 10 ASSAYS W/ASH | AACC: Crosswalk to 84460 + 83520 + 82172 + 82247 + 82977 + 83010 + 84450 + 82947 +82465 + 84478 ACLA: Administrative MAAA CPTs are not assigned an NLA ASCP: ASCP is not offering recommendations for this code, as it is an administrative MAAA code that is not intended to be on a fee schedule CAP: No comment | $106.84 |
| 0003M LIVER DISEASE 10 ASSAYS W/NASH | AACC: Crosswalk to 84460 + 83520 + 82172 + 82247 + 82977 + 83010 + 84450 + 82947 + 82465 + 84478 ACLA: Administrative MAAA CPTs are not assigned an NLA ASCP: Administrative MAAA CPTs are not assigned an NLA CAP: No comment | $106.84 |
| 815XX3 Fetal Aneuploidy (trisomy 21, 18, and 13) | ACLA, ASCP: Gap-fill CAP: No comment | |
| 81500 ONCO (OVAR) TWO PROTEINS | AACC: Crosswalk to 86304 + 86305 ACLA, ASCP: Crosswalk to 86304 + 86305 + 33% of 87900 CAP: No comment | $57.22 $116.34 |
| 81503 ONCO (OVAR) FIVE PROTEINS | AACC: Crosswalk to 86304 + 82172 + 82232 + 84466 + 84134 ACLA, ASCP: Gap-fill CAP: No comment | $109.75 |
| 81506 ENDO ASSAY SEVEN ANAL | AACC: Crosswalk to 82947 + 83036 + 83525 + 86141 + 83520 + 84466 + 83520 ACLA, ASCP: Gap-fill CAP: No comment | $105.39 |
| 81509 FTL CGEN ABNOR THREE ANAL | AACC, ACLA, ASCP: Crosswalk to 86336 + 84163 + 84702 CAP: No comment | $62.82 |
| 81510 FTL CGEN ABNOR FOUR ANAL | AACC, ACLA, ASCP: Crosswalk to 82105 + 82677 + 84702 CAP: No comment | $77.01 |
| 81511 FTL CGEN ABNOR FOUR ANAL | AACC ACLA, ASCP: Crosswalk to 82105 + 82677 + 84702 + 86336 CAP: No comment | $98.43 |
| 81512 FTL CGEN ABNOR FIVE ANAL | AACC: Crosswalk to 82105 + 82677 + 84702 (x2) + 86336 ACLA, ASCP: Crosswalk to 82105 + 82677 + 84702 + 86336 + 82397 CAP: No comment | $119.13 $117.85 |
| 82777 Galectin-3 | AACC, ACLA, ASCP: Crosswalk to 83937 CAP: No comment | $41.03 |
| *Acronyms: AACC, American Association for Clinical Chemistry; ACLA, American Clinical Laboratory Association; ASCP, American Society for Clinical Pathology; and CAP, College of American Pathologists. *CPT Codes © American Medical Association. Note: digits marked by XX are to be finalized. | ||
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