ANNUAL NOTICE - Parkview Health
| | | | |
|ELECTROLYTE PANEL |BASIC METABOLIC |LIPID PROFILE |HEPATITIS PANEL |
| | | | |
|CPT 80051 - $8.71 |CPT 80048 – $8.71 |CPT 80061 - $18.27 |CPT 80074 - $59.65 |
| | | |Hepatitis A Ab, IgM |
|Sodium |Electrolytes |Cholesterol |Hepatitis B Core Ab, IgM |
|Potassium |BUN |Triglyceride |Hepatitis B Surface Ag |
|Chloride |Creatinine |HDL Cholesterol |Hepatitis C Antibody with Riba |
|CO2 |Glucose |LDL Cholesterol- Calculated |Reflex |
| |Calcium |Chol/HDL Ratio- Calculated | |
| | | | |
|COMPREHENSIVE METABOLIC PANEL |LIVER PROFILE (HEPATIC) |RENAL FUNCTION PANEL |OB PANEL |
| | | | |
|CPT 80053 – $14.20 |CPT 80076 - $8.71 |CPT 80069 - $11.85 |CPT 80055 – Billable as individual|
| | |Lytes |tests total of $64.33 |
|Electrolytes |Albumin |Albumin | |
|Albumin |Bilirubin Total |Calcium |CBC with Differential |
|Alkaline Phos |Bilirubin Direct |BUN |Hep B Surface Antigen |
|ALT |Alkaline Phosphorus |Creatinine |Rubella |
|AST |ALT |Glucose |RPR |
|Bilirubin, Total |AST |Phosphorous |ABO, RH |
|BUN |Protein, Total | |Antibody Screen |
|Calcium | | | |
|Creatinine | | |This panel may reflex 85007, 85008,|
|Glucose | | |87341, 86593 and/or 86870. |
|Protein, Total | | | |
We will continue to recognize the following traditionally ordered panels.
| | | | |
|CHEM 6 |HYPERALIMENTATION |THYROID PANEL |THYROID PANEL W/ TSH |
| | | | |
|Electrolytes (CPT 80051 –$8.71) |Electrolytes (CPT 80051 –$8.71) |T4 (CPT 84436 - $9.37) |T4 (CPT 84436 - $9.37) |
|BUN (CPT 84520 - $5.39) |Calcium (CPT 82310 - $7.04) |T-Uptake (CPT 84479 - $8.83) |T-Uptake (CPT 84479 - $8.83) |
|Creatinine (CPT 82565 - $6.99) |Magnesium (CPT 83735 - $9.14) |FTI (Calculation) |FTI (Calculation) |
| |Phosphorous (CPT 84100 - $6.48) | |TSH (CPT 84443 - $22.93) |
Medicare payment is based upon the number of tests ordered. The following is the Medicare fee schedule for automated chemistry tests. Medicaid reimbursement amounts will be equal to or less than the amount of Medicare reimbursement.
|2 Tests = $7.10 |3 Tests = $8.71 |4 Tests = $8.71 |5 Tests = |6 Tests = $8.71 |7 Tests = |
| | | |$8.71 | |$8.71 |
|8 Tests = $8.71 |9 Tests = $11.85 |10 Tests = $11.85 |11 Tests = $12.05 |12 Tests = $12.31 |13-16 Tests = $14.20 |
|17-18 Tests = $14.52 |19 Tests = $15.10 |20 Tests = $15.57 |21 Tests = $16.07 |22 Tests = $16.55 |23 Tests = $16.55 |
Reflexive Testing Guide
Common tests that are automatically reflexed are listed on the next page. For additional information refer to the PHL test directory for CPT coding, billing information and Medical Necessity Requirements.
|Test Name | CPT |Test Name | CPT |Test Name | CPT |
|Reflexed Test | |Reflexed Test | |Reflexed Test | |
|Acid Fast | |Fungal Culture | |Stool Culture* |87045 |
|Culture* |87116 |Blood* |87103 |Pathogens |87046 |
|Blood Culture* |87040 |Fungal Culture | | | |
|Respiratory |87070 |Other* |87102 | | |
|Culture* | |Fungal Hair/Nails* |87101 | | |
|GU Culture* |87070 |Throat Culture* |87081 |Herpes Culture* |87255 |
|Aerobic Culture* |87070 |Urine Culture * |87086 |Immunofluorescent typing |87140 |
|Anaerobic |87075 | | | | |
|Culture* | | | | | |
|*All cultures above may include and/or reflex charges for: |
|Gram Stain – 87205 |
|Sensitivities – 87181 & 87184 & 87185 & 87186 |
|Serologic Typing – 87147 |
|Organism ID – 87076 & 87077 & 87088 |
|*Fungal cultures may include and/or reflex charges for: |
|Yeast – 87106 and/or Mold – 87107 |
|KOH prep - 87220 |
|DRUX (Quantitative Urine Drug Screening) may reflex the following confirmations: |
|Amphetamines (Confirmation/Quantitation) |82145 |Cannabinoid or Methaqualone |82542 |
|Benzodiazepine (Confirmation/Quantitation) |80154 |(Confirmation/Quantitation) | |
|Barbiturates (Confirmation/Quantitation) |82205 | | |
|Cocaine (Confirmation/Quantitation) |82520 |Opiates (including but not limited to): |83925 |
|Phencyclidine-PCP (Confirmation/Quantitation) |83992 |Codeine, Hydrocodone, Hydromorphone, | |
|Methadone (Confirmation/Quantitation) |83840 |Oxycodone, Oxymorphone | |
|Propoxyphene (Confirmation/Quantitation) |83925 |(Confirmation/Quantitation) | |
| |
eflexive Testing Guidelines
-----------------------
Labview Annual Notices
FOR CLIENTS OF PARKVIEW HEALTH LABORATORIES September 2014
ANNUAL NOTICE TO PHYSICIANS
The Office of the Inspector General requires that laboratories annually inform physicians of the following information:
With all chemistry panels, the physician is to only order those tests, which are medically necessary for the diagnosis or treatment of the patient. Panels will be billed as one test when all components are medically necessary. If all the tests in the panel are not medically necessary, the individual tests should be ordered. When ordered tests are not deemed medically necessary, patients may be asked to sign an Advanced Beneficiary Notice.
Advanced Beneficiary Notice:
A valid diagnosis is required for each laboratory test ordered. Medicare may not consider certain tests, diagnoses or ordering frequencies to be medically necessary and will not reimburse for such testing. These tests will require the patient to sign an Advanced Beneficiary Notice before the specimen can be collected, allowing the laboratory to bill the patient for testing.
CMS and WPS have medical necessity requirements for the following tests.
National Coverage Determination (NCD’s):
AFP, CA-125, CA 15-2, CA 19-9, CEA, Collagen Cross Links, Digoxin, Lipid Testing, GGT, Glucose, Glycohemoglobin, HCG, Hepatitis tests, HIV Diagnostic and Prognostic, Iron Studies (including Iron, Iron Binding Capacity, Transferrin and Ferritin), Occult Blood , Protime, PSA, APTT, Thyroid Function Testing (including Free and Total Thyroxin, TSH, T3 or T4 Uptake or THBR) and Urine Cultures.
Local Coverage Determination (LCD’s):
Cytogenetic Testing, Flow Cytometry Testing, Molecular Testing, Qualitative Drug Testing, Allergy IgE Testing and Vitamin D.
.
For more information, please see websites;
On the next page is the list of standardized panels. These panels were developed by the AMA for coding purposes only, and should not be interpreted as clinical parameters. Medicare reimbursement rates are listed next to the CPT codes.
Inside This Issue
1. Annual Physician Notices
2. Reflex Testing Notification
Parkview Regional Medical Center
Parkview Hospital Randallia
Parkview Huntington Hospital
Parkview Whitley Hospital
Parkview North Hospital
Parkview Noble Hospital
And Parkview Lagrange Hospital
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