Molecular Pathology: 83890-83914: Keep On Piling in 2012

Notice payer guidance for novel MoPath codes -- some might surprise you.

With Medicare payment for 101 CPT codes 2012 meant for molecular pathology codes (81200-81048) hanging in the wind, does that mean you mustn't use the codes? That depends.

One thing is clear – a lot of payers will continue accepting the molecular diagnostics "stacking codes" (83890-83914,Molecular diagnostics …) this year. Despite AMA instruction to use the stacking codes merely for services not defined by new Tier 1 or Tier 2 codes, CMS's failure to price the new CPT codes 2012 keeps 83890-83914 in the spotlight.

CMS to Labs: Usage of Both Code Families

You're used to billing molecular diagnostics with stacking CPT codes 83890-83914, and that doesn't change in 2012 for most payers.

Use novel codes, too: Medicare desires that, besides the stacking codes, labs furthermore list the novel single CPT code that would be eventually used for payment purposes in case the CPT codes 2012 were active. CMS also demands that your Medicare claims reveal a charge for the new CPT code, although the Medicare acceptable for the new molecular pathology procedure CPT codes 2012 is $0.00.

Here's why: The Physician Fee Schedule lists molecular pathology CPT codes 81200-81408 with procedure status indicator "B" (Bundled Code Payments for covered services are always bundled into payment for other services not specified…).

However these services would traditionally be allocated a procedure status indicator of "I" (Not Valid for Medicare purposes Medicare uses another code for the reporting of, and the payment for these services), assigning these particular CPT codes a procedure status of B will permit CMS to collect claims information significant to assessing eventual pricing of these novel molecular pathology CPT codes 2012.

Opportunity: Even though Medicare doesn't need labs to list novel molecular pathology CPT codes 2012, doing so gives you an opportunity to provide pricing information that could impact the subsequent payment for these services.

Do this: You can make available pricing input meant for molecular pathology tests that your lab carries out by implementing the following listed steps and safeguards:

• Have the Medicare transmittal along with your compliance documents.
• Report the applicable 81200-81408 CPT code and price it as per the amount you believe signifies its fair market value, identifying that the amount may be different than the sum of the prices you've given to the stacking CPT codes.
• For the reason that CMS doesn't offer a modifier or any other mechanism to specify that the molecular pathology CPT code (from the range 81200-81408) on your claim is non-payable, you must observe all such claims to confirm that your Medicare contractor rejects the charge submitted with the novel CPT code 2012.