(Medicare Claims Processing Manual)

Clarification of the Use of the Term Screening or Screen"   The final rule clarifies that effective February 21, 2002, the use of the term screening or screen in CPT code descriptor does not necessarily describe a test performed in the absence of signs and symptoms of illness, disease or condition.  A/B MACs (A ) and (B) do not deny a service based solely on the presence of the term screening or screen in the descriptor.   Tests that are performed in the absence of signs, symptoms, complaints, personal history of disease, or injury are not covered except when there is a statutory provision that explicitly covers tests for screening as described.   If a person is tested to rule out or to confirm a suspected diagnosis because the patient has a sign and/or symptoms, this is considered a diagnostic test, not a screening test.  A/B MACs (A) and (B) have discretionary authority to make reasonable and nece ssary scope of benefit determinations.  120.2 - Implementation and Updates of Negotiated National Coverage Determinations (NCDs) for Clinical Diagnostic Laboratory Services  (Rev. 3014, Issued:  08- 06-14, Effective:  ICD -10:  Upon Implementation of ICD -10 ASC- X12:  01- 01-12, Implementation:  ICD -10:  Upon Implementation of ICD -10 ASC X12: 09 -08-14)  Under a negotiated rulemaking process, the Center for Medicare & Medicaid Services (CMS) developed 23 NCDs for clinical diagnostic laboratory services.  The NCDs are applicable to services billed under Part B regardless of the entity providing the services .  Thus, they are binding on A/B MACs (A and B) in processing clinical diagnostic laboratory services on an outpatient basis.  In order to ensure uniformity in the implementation of the NCDs, CMS developed the NCDs utilizing three lists of diagnosis codes.  Every diagnosis code will fall into one the three lists.  The lists included:  Codes Covered by Medicare, Codes Denied, and C odes That Do Not Support Medical Necessity.  Related software, called the laboratory edit module, is incorporated in the shared systems so that laboratory claims subject to one of the 23 NCDs are processed uniformly throughout the nation.  In addition, the NCDs are maintained through the NCD process that was announced in the " Federal Register"  on September 26, 2003 (68 FR 55634).  This process provides for public participation through a comment period at the beginning of the evaluation of the issue and includes a detailed decision document that outlines the rationale for the decision.  These documents may be viewed on the Medicare coverage homepage at cms.hhs.gov/coverage.   On a quarterly basis, CMS will update the NCD edit module as necessary for ministerial coding changes and to implement the NCD decisions described above.  CMS assures the updated software is communicated to the shared system maintainers.  The shared system  maintainers install the revised edit module after testing and distribute it to the A/B MACs (A and B) as part of their routine release.  A/B MACs (A and B) will conduct provider education to advise the laboratories of changes to the laboratory edit module  quarterly.  Exhibit 1 - List of Diagnostic Tests that are Considered End Stage Renal Disease (ESRD)  (Rev. 1769, Issued:  07- 10-09, Effective/Implementation:  07 -31-09)  Refer to section 40.6.2.3 for guidance on the usage of this list.  71010 Chest x- ray 71015 Chest x- ray 71020 Chest x- ray 71021 Chest x- ray 71022 Chest x- ray 71030 Chest x- ray 71035 Chest x- ray 73120 X -ray hand  75710 Artery x- rays, arm/leg  75716 Artery x- rays, arm/leg  75774 Artery x- rays, arms/legs  75790 Artery x- ray, each vessel  75820 Visualize A -V shunt  75822 Vein x- ray, arm/leg  75893 Vein x- ray, arms/legs  75894 Transcath therapy, embolization 75896 X -rays, transcath therapy  75898 X -rays, transcath therapy  75901 Mechanical removal of pericath obstructive material  75902 Mechanical removal of intraluminal obstructive material  75961 Transcath retrieval of intravascular foreign body 75962 Transcath balloon angioplasty 75964 Transcath balloon angioplasty, each additional  76070 Computed tomography, bone mineral density study, axial  76075 Dual energy DEXA, bone density study, axial  76080 Radiologic exam, abscess, fistual or sinus tract study  76092 Screening mammography bilateral  76778 Ultrasound, transplanted kidney  78070 Parathyroid nuclear imaging 78351 Bone density, dual photon absorptionmetry 80048 Basic metabolic panel  80051 Electrolyte panel  80053 Comprehensive Metabolic Panel  ? 80061 Lipid panel  80069 Renal function panel  80074 Acute hepatitis panel  80076 Hepatic function panel  80197 Tacrolimus  80410 Calcitonin stim panel  81000 Urinalysis with microscopy  81001 Urinalysis, auto w/scope  81002 Urinalysis nonauto w/o scope  81003 Urinalysis, auto, w/o scope  81005 Urinalysis, qual or semi -quant  81007 Urine screen for bacteria, except by culture or dipstick 81015 Microscopic exam of urine  82009 Test for acetone/ketones,qual  82010 Acetone assay, quant  82017 Acylcarnitines, quant  82040 serum albumin 82042 albumin, urine quant or other source  82108 Assay of aluminum  82232 Beta2microglobulin (monitor large molecular weigh solute clearance by dial  82247 Bilirubin, total  82248 Bilirubin, direct  82306 Assay of vitamin D -3 (calcifediol)  82307 Assay of vitamin D (calciferol)  82308 Assay of calcitonin 82310 Assay of calcium  82330 Assay of calcium, ionized  82374 Bicarbonate (CO2)  82379 Assay of carnitine  82435 Chloride blood (needed to determine acid/base status)  82465 cholesterol, total serum  82550 CPK, total  82565 Assay of creatinine  82570 Assay of urine creatinine  82575 urine creatinine clearance test  82607 Vit B12 82728 ferritin  82746 serum folate  82747 RBC folate  82800 Blood Ggases, ppH onlyy 82803 Blood gases: pH, pO2 & pCO2 82805 Blood gases W/02 saturation 82810 Blood gases, O2 sat only 82945 Glucose other fluid 82947 Assay, glucose, blood quant  82948 Reagent strip/blood glucose  83540 Assay of iron  83550 Iron binding test  83735 magnesium (monitored to avoid hypermagnesium)  83937 Osteocalcin  83970 parathormone (PTH)  83986 Assay of body fluid acidity 84075 alkaline phosphatase  84100 Assay of phosphorus, inorganic  84105 urine phosphorus  84132 Assay of serum potassium  84133 urine potassium  84134 Assay of prealbumin 84155 Assay of protein  84160 serum protein by refractometry  84295 Assay of serum sodium  84315 Body fluid specific gravity  84450 Transferase (AST) (SGOT)  84460 Alanine amino (ALT) (SGPT)  84466 transferrin  84520 Urea nitrogen, quantitative  84540 Assay of urine/urea -n 84545 Urea -N clearance test  84630 zinc  85002 Bleeding time test  85004 Automated diff wbc count  85007 Bl smear w/diff wbc count  85008 Bl smear w/o diff wbc count  85009 Manual diff wbc count b- coat 85013 Spun microhematocrit  85014 Hematocrit  85018 Hemoglobin 85025 Complete CBC w/auto diff wbc  85027 Complete CBC, automated 85032 Manual cell count, each  85041 Automated RBC count  85044 Manual reticulocyte count  85045 Automated reticulocyte count  85046 Reticyte/hgb concentrate  85048 Automated leukocyte count  85049 Automated platelet count  85345 Coagulation time, Lee -White  85347 Coagulation time, activated  85348 Coagulation time, other methods  85520 Heparin assay  85610 Prothrombin time  85611 Prothrombin test,substitution  85651 sed rate  85652 automates sed rate  85730 thromboplastin time, partial (PTT)  85732 Thromboplastin time, partial, substitution  86590 Streptokinase, antibody 86644 CMV screen  86645 Cytomegalovirus antibody dfa (IgM)  86687 HTLV -I antibody 86688 HTLV -II antibody  86689 HTLV/HIV confirmatory test  86692 Hepatitis, delta agent  86701 HIV -1 86702 HIV -2 86703 HIV -1/HIV2, ,singgle assayy  86704 Hep B core antibody, total  86705 Hep b core antibody, IgM  86706 Hep B surface antibody 86707 Hep Be antibody  86709 Hep A, IgM antibody 86803 Hepatitis C ab test  86804 Hep C ab test, confirm  86812 HLA typing, A, B, or C  86813 HLA typing, A, B, or C, multiple antigens  86816 HLA typing, DR/DQ  86817 HLAy tpypigng, DR/DQ, multiple antigens  86900 Blood typing, ABO  86901 Rh typing  86903 Blood typing, antigen screen  86904 Blood typing, patient serum  86905 Blood typing, RBC antigens  86906 Blood typing, Rh phenotype  87040 culture, blood 87070 Culture, bacteria, other  87071 Culture bacteri aerobic other, quant  87073 Culture bacteria anaerobic, quant  87075 Culture bacteria anaerobic, any source w/ID  87076 Culture anaerobe ident, each  87077 Culture aerobic identify 87081 Culture screen only 87084 Culture w/ colony estimation 87086 Urine culture/quant colony count  87088 Urine bacteria culture, isolation & ID  87181 Microbe susceptible, diffuse  87184 Microbe susceptible, disk 87185 Microbe susceptible, enzyme  87186 Microbe susceptible, mic  87187 Microbe susceptible, mlc  87188 Microbe suscept, macrobroth  87190 Microbe suscept, mycobacteri  87197 Bactericidal level, serum  87205 Smear, gram stain  87271 CMV, DFA  87340 HepB surface antigen 87341 HepatitisB  surface, ag, eia, neutralization  87350 HepatitisBe ag, eia  87380 Hepatitis delta ag, eia  87390 HIV -1 ag, eia  87391 HIV -2 ag, eia  87515 Hepatitis B, DNA, dir probe  87516 Hepatitis B, DNA, amp probe  87517 Hepatitis B, DNA, quant  87520 Hepatitis C, RNA, dir probe  87521 Hepatitis C, RNA, amp probe  87522 Hepatitis C, RN A, quant  87525 Hepatitis G, DNA, dir probe  87526 Hepatitis G, DNA, amp probe  87527 Hepatitis G, DNA, quant  89050 cell count, peritoneal fluid (no diff)  89051 cell count, peritoneal fluid with diff  93000 Echo exam of heart  93005 Electrocardiogram, tracing  93010 Electrocardiogram report  93040 Rhythm ECG with report  93041 Rhythm ECG, tracing 93042 Rhythm ECG with report  93307 Echo exam of heart  93308 Echo exam of heart, follow -up 93922 Extremity study  93923 Extremity study, multiple levels  93925 Lower extremity study -  arterial  93926 Lower extremity study, limited-  arterial  93930 Upper extremity study-  arterial  93931 Upper extremity study, limited- arterial  93965 Extremity study- venous  93970 Extremity study- venous  93971 Extremity study, limited- venous  G0001 Routine venipuncture  G0202 Screening mammography, digital