CPT codes

Edition 6: CMS Makes Changes to the -59 Modifier

Effective January 1, 2015, CMS has introduced four new modifier subsets of the -59 Modifier in order to better define a “Distinct Procedural Service”. Currently providers can utilize modifier -59 to indicate that a CPT code is separate but distinct from another service that could be bundled. CMS feels that this modifier’s usage has been applied broadly and as such has been applied incorrectly by providers. High levels of abuse and fraud have been associated with this modifier. The primary issue with the -59 modifier is that it is defined for use in a wide variety of circumstances such as different encounters, anatomical sites and distinct services.

The four new HCPCS subsets of the -59 Modifier are:

XE- separate encounter

XP- separate practitioner

XS-separate organ/structure

XU- unusual non-overlapping service …(Read More Here)

Edition 5: 2015 Laboratory Fee Schedule and Sequestration 

Effective January 1, 2015 the Clinical Lab Fee Schedule (CLFS) saw a reduction of 0.3%. You can access the 2015 CLFS at

http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/clinlab.html

In addition, CMS proposed several new changes for CPT codes 80300 through 80377 for 2015. These codes represent various drug screening codes, many which are specific to individual drug testing. Several of the 2014 drug testing CPT codes were deleted as well as specific individual drug codes added. On October 9, 2014, CMS decided to review these proposed changes and…(Read More Here)

Edition 5: 2015 Laboratory Fee Schedule and Sequestration

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Effective January 1, 2015 the Clinical Lab Fee Schedule (CLFS) saw a reduction of 0.3%. You can access the 2015 CLFS at http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/clinlab.html.

In addition, CMS proposed several new changes for CPT codes 80300 through 80377 for 2015. These codes represent various drug screening codes, many which are specific to individual drug testing. Several of the 2014 drug testing CPT codes were deleted as well as specific individual drug codes added. On October 9, 2014, CMS decided to review these proposed changes and delay pricing due to concerns with over payment. In the mean time several of the deleted test codes were to be reported with the new test codes that CMS is not recognizing. In order to rectify this over sight, CMS has created several new alpha numeric G codes to replace the 2014 CPT codes that were deleted in 2015. You can access a full list of the temporary G codes and specific drugs that were cross walked at: (more…)

Edition 1: Medicare’s Coverage for Sexually Transmitted Infections Screening Tests[1],[2]

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Medicare now provides coverage for screening of sexually transmitted infections (STIs) as well as coverage for high intensity behavioral counseling (HIBC) to prevent STIs. The screening tests that will be covered are for Chlamydia, Gonorrhea, Syphilis and Hepatitis B.

 

Chlamydia and Gonorrhea Screening

Chlamydia and Gonorrhea screening tests are only indicated for the following beneficiaries:

  • Pregnant women who are 24 years old or younger when the diagnosis of pregnancy is known then repeat testing during the third trimester if high-risk sexual behavior has occurred since the initial screening test
  • Pregnant women who are at increased risk for STIs when the diagnosis of pregnancy is known then repeat testing during the third trimester if high-risk sexual behavior has occurred since the initial screening test
  • Women at increased risk for STIs annually

(more…)

Edition 1: Medicare’s Coverage for Sexually Transmitted Infections Screening Tests[1],[2]

Medicare now provides coverage for screening of sexually transmitted infections (STIs) as well as coverage for high intensity behavioral counseling (HIBC) to prevent STIs. The screening tests that will be covered are for Chlamydia, Gonorrhea, Syphilis and Hepatitis B.

Chlamydia and Gonorrhea Screening

Chlamydia and Gonorrhea screening tests are only indicated for the following beneficiaries:

  • Pregnant women who are 24 years old or younger when the diagnosis of pregnancy is known then repeat testing during the third trimester if high-risk sexual behavior has occurred since the initial screening test
  • Pregnant women who are at increased risk for STIs when the diagnosis of pregnancy is known then repeat testing during the third trimester if high-risk sexual behavior has occurred since the initial screening test
  • Women at increased risk for STIs annually …(Read More Here)