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laboratory cpt codes

Insurers Are Rejecting Many PLA, MAAA Codes

>>CEO SUMMARY: Clinical labs developing innovative tests face a challenge getting paid. While Medicare may reimburse for these tests, some commercial payers and state Medicaid programs are not paying for new proprietary laboratory analyses (PLA) codes and multianalyte assays…

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Georgia Lab Pays Docs For Urine Test Referrals

CEO SUMMARY: Physicians could make $400 or more per sample, according to one physician. But under the federal Stark Law, the federal Anti-kickback Law, and under Florida state law, physicians and other healthcare providers are prohibited from referring patients or doing work for kickbacks…

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Medically Unlikely Edits Are Back–and a Problem!

CEO SUMMARY: On January 1, 2009, CMS implemented Phase VIII of its policy on medically unlikely edits (MUEs) involving about 100 laboratory CPT Codes. It also began to deny whole claims, not just the “medically unlikely” parts of claims. After hearing of the problem in early …

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Lab MUEs Reconsidered, CMS Changes Course

CEOSUMMARY: It may bear are moment of common sense. Last month, Medicare officials stated their intent to exclude clinical laboratory and anatomic pathology CPT codes from the “Phase One” implementation of Medically Unbelievable Edits (MUEs). It is a positive step, and comes in respon…

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CMS Defers MUE Edits Until After Jan. 1, 2007

CEO SUMMARY: Medicare officials have granted a temporary respite on the troubling proposal to institute service restrictions per patient on some 80 pathology CPT codes and 1,100 clinical laboratory codes. These proposals are part of a new round of Medically Unbelievable Edits (MUEs). CMS …

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