Compliance Question of the Week – Laboratory

What is the Medicare policy for packaging of laboratory tests?

How should modifier 91 be reported under the National Correct Coding Initiative (NCCI) program?

For 2018, what codes should be used for drug-of-abuse testing?

When will CMS make a decision about whether to go ahead with the new, but inadequate, CLFS rates?

Last week you gave a list of options that a referring lab must meet to be able to bill for clinical lab tests on the CLFS. We are interested in the one about the lab not referring more than 30 percent of the tests for which it receives testing requests, etc. How does CMS determine the 30 percent exception option?

Can a referring lab bill for clinical laboratory diagnostic tests on the CLFS?

Is there more than one unlisted code for lab tests that have no CPT® codes?

Do you have any idea whether CMS will go ahead with the preliminary CLFS rates or make changes due to the industry’s negative response?

Which test and code are recommended for reporting hypo- or hyperthyroid states?

Do you know what the payment rate would be for CPT® codes 85025 (CBC) and 80061 (lipid panel) under the new proposed CLFS?

What does PAMA specifically say about CLFS payment rate decreases? I know that CMS has proposed reductions for 2018, and I just wonder how these comply with the original law.

Is there any word yet from CMS on the new CLFS rates for 2018?