Laboratory Question for the Week of December 31, 2018

Question:

For the CMS date of service policy update, does the date performed apply to molecular testing that is done in-house for Medicare outpatients, or is it only for testing that is sent to a reference lab, which must bill?

Answer:

The date performed is based on the Medicare policy, which applies when the molecular pathology test is ordered and done at least 14 days following the patient’s discharge from the hospital. When the additional policy requirements are met, the performing laboratory must bill Medicare directly for the test. For more information on this, go to https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ClinicalLabFeeSched/Clinical-Lab-DOS-Policy.html.