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PAP 273

Molecular Pathology Codes


Provider Administrative Policy

Section
Claims Submission
Policy Date
January 2012
Status/Date
New/January 2012
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Molecular Pathology Codes

Effective January 1, 2012 the American Medical Association created 101 new Current Procedure Terminology (CPT) codes for molecular pathology procedures. These CPT codes range 81200 to 81408 and correspond to existing CPT codes that are "stacked" to represent a given test. The Centers for Medicare and Medicaid Services (CMS) is not assigning any relative value units or pricing to the 101 new codes. They are all assigned a payment status indicator of "B" indicating they are bundled into payment for other services. So for payment purposes, CMS is requesting that providers report these new codes in combination with the currently existing "stacked" CPT codes.

Blue Cross of Idaho is following CMS' lead and pricing the new molecular pathology procedure codes at $0.00. While the allowances for CPTs 81200-81408 will be set at $0, we do ask that providers assign a charge amount for these tests. These charge amounts will help us assign appropriate pricing in the years ahead. Additionally, providers must obtain a prior authorization for these, as well as all other genetic testing services.

After obtaining a prior authorization, and in order for your claims to process with an allowance, please submit your claims with both the existing "stacked" CPT codes that are required for payment (83890-83914) and the new single CPT code (81200-81408). All codes should reflect provider pricing on your claims. Only 83890-83914 will have an allowance and will price according to your fee schedule.

This policy applies to all Blue Cross of Idaho local providers. Out of state Blue Cross Blue Shield Plans may have elected other pricing mechanisms for the 101 new codes.

For more information on the CMS changes, please see MLN Matters Numbers MM7654 and MM7671.


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