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Question:
When it comes to panels, does Medicare allow labs to substitute one test for another?
Answer:
The test composition of the panels at your facility must be exactly as stated in the CPT manual. You may not substitute one test for another, nor add to or subtract from those listed. Performance of fewer than the specified tests listed in the panel whose code you report is considered up-coding and a major compliance issue. Performance of more than the specified tests listed for a panel could lead to concerns about inducement or questions concerning the tests’ medical necessity.
CPT® copyright 2023 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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