Pathology/Lab Coding Alert

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you-ll know that Medicare has deleted the code from the current year's fee schedule, usually because the CPT code is no longer valid.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.



Pathology/Lab Coding Alert
Issue - Oct, 2007
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