New Jersey Administrative Code › Title 10 - HUMAN SERVICES › Chapter 61 - INDEPENDENT CLINICAL LABORATORIES › Subchapter 3 - HEALTHCARE COMMON PROCEDURE CODING SYSTEM HCPCS › Section 10:61-3.5 - Pathology and Laboratory HCPCS Codes-Qualifiers

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Qualifiers for
				pathology and laboratory services are summarized below:
1. Codes 80048, 80050, 80051, 80053, 80055,
				80061, 80069, 80074, 80076. The panels listed must include the laboratory tests
				assigned by the CPT as the components of the panel. The tests listed with each
				of the panels identify the defined components of that panel. If any three
				laboratory tests included in the panel are billed a la carte, the tests must be
				billed as the panel. The laboratory provider may not charge Medicaid/NJ
				FamilyCare more than the lowest charge level offered to another provider. The
				lowest charges for the laboratory test comprising the panel must aggregate as
				equivalent to or greater than the listed panel fee.
2. Codes 82487, 82488, and
				82489--Chromatography--must list substance (compound) tested for in block 34
				(REMARKS) of the claim form.
3.
				Code 84081--Phosphatidylglycerol--test done on newborn or amniotic fluid to
				determine fetal lung maturity.
4.
				Code 84202--Protoporphyrin, RBC; quantitative--Utilize only for testing of
				anemia. Utilize code 84203--Protoporphyrin, RBC; screen when testing for
				anemia. Code 84203 will not be reimbursed when billed in conjunction with code
				83655--Blood lead determination (quantitative).
5. Code 84620--Xylose absorption tests, blood
				and/or urine (D-xylose tolerance test), includes serum and urine levels, up to
				five hourly specimens.
6. Codes
				85025 and 85027 Hematology
i. For purpose of
				reimbursement based on this schedule, a complete blood count (CBC) includes a
				hematocrit, hemoglobin determination, RBC count, RBC indices, WBC count and
				differential WBC count.
ii.
				Hematology codes 85014, 85018, 85041 and 85048 will not be reimbursed in
				conjunction with codes for blood count with hemogram (85025 and
				85027).
iii. The code for manual
				differential WBC count (85007) will not be reimbursed in conjunction with codes
				85025 and 85027.
iv. Codes for
				platelet count 85049 will not be reimbursed in conjunction with codes 85025 and
				85027.
7. Codes 87040,
				87045, 87046, 87070, 87184--Cultures
Note: These codes may only be billed when a pathogenic
				  microorganism is reported. A culture that indicates no growth or normal flora
				  must be billed as a presumptive culture, 87081.
8. Code 88155--Pap smear
Note: Obtaining specimen is not a separate eligible
				  service.
9. Codes 88348 and
				88349--Electron microscopy; diagnostic and scanning are not reimbursable when
				used as a research tool.
Note: For reimbursement purposes, Medicaid will pay for the
				  above diagnostic scanning procedure when it pertains to x-ray microanalysis for
				  identification of asbestos particles and heavy metals, that is, gold, mercury,
				  etc. and also when examining tissue specimens in occasional cases of
				  malabsorption.
10. Code
				W8900--This code may be used only once per trip regardless of the number of
				beneficiaries seen and requires a distance in excess of 20 miles per round
				trip.
11. Codes 87901, 87903, 87904
				and 87999--These codes for Antiretroviral Resistance Testing (ART) shall be
				limited to three tests per 12-month period.
i.
				Genotype testing has one code: 87901. Code 87999 is a temporary procedure code
				for virtual phenotype that must be ordered in conjunction with 87901. The
				temporary HCPCS code for 87999 is 0023T.
ii. Phenotype testing has two codes. The
				primary code, 87903, covers the first 10 drugs that are tested. The second
				code, 87904, shall be used for each additional drug, up to five drugs. The CPT
				manual specifies that code 87904 must be used in conjunction with 87903. In
				addition, each drug tested shall be listed separately in conjunction with
				billing for 87904.