Will Medicare Pay? Fee Schedule Status Indicators Hold the Answer- Published on Mon, Oct 29, 2007
Check out Medicare's online tool to speed up your search
Price isn't everything--or the only thing--that you-ll learn from the Medicare Physician Fee Schedule. You-ll also learn the status of certain codes indicating whether--or how--Medicare might compensate your pathologist's work.
Watch Status Indicators for Coverage Policy
The MPFS includes a -Procedure Status- column that lists a one-letter status code. The procedure status indicator can provide a great deal of information about how Medicare pays for the particular service, according to Jan Rasmussen, CPC, AGS-GI, ACS-OB, president of Professional Coding Solutions in Eau Claire, Wis.
Procedure Status -A-: Most years, almost all pathology codes have an -A- status indicator, meaning that the code is active and payable on the Physician fee schedule
. However, some years you may see one or more of the following status codes that indicate how (or if) Medicare will pay for the service:
Procedure Status -C-: A status indicator of -C- says that the service is carrier-priced, meaning that Medicare does not give national or GPCI RVU amounts for the procedure.
Procedure Status -D-: If you see a -D,- you-ll know that Medicare has deleted the code from the current year's fee schedule
, usually because the CPT code is no longer valid. Consider a -D- a gentle reminder that you should be using the most current CPT codes for your procedures.
Procedure Status -I-: If Medicare requires that you report a code other than the CPT code, such as a HCPCS Level II code, for a specific service, you-ll see an -I- in the procedure status column. That means the code is invalid for Medicare purposes.
Scrutinize the Fee Schedule
CMS publishes a new Physician Fee Schedule each year in the Federal Register, usually in early November. When you look at the Federal Register, you-ll see the modifier column along with columns that break down the RVUs for each code. But you won't see the procedure status column or the PC/TC column discussed in the preceding story, -More Than a -Fee- List--Harness MPFS Policy Rules for TC/PC.-
Do this: To find Medicare's payment policy indicators and/or pricing information, you can access the most current MPFS version, including quarterly updates, on the Internet at www.cms.hhs.gov/PFSlookup/
You can access the status and PC/TC indicator columns from this Web site by selecting -Physician Fee Schedule Search,- then selecting -Payment Policy Indicators- from the heading -Type of Information.- The search engine will display these (and other) policy indicator columns for the CPT codes you request in your search.
Want more code info & how to -
articles for Pathology/Lab Codes?
Sign-up for Pathology/Lab Coder's FREE Trial Today to:
- Simplify pathology/lab codes? code lookup across CPT®, ICD-9, ICD-10, & HCPCS codes