CMS Adds Two Codes to CLIA Edits

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  • July 29, 2011
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The Centers for Medicare & Medicaid Services (CMS) recently added to the list of laboratory and pathology codes subject to Clinical Laboratory Improvement Amendments (CLIA) regulations, which require a facility to be appropriately certified for each test performed. Facilities should be aware of two CPT® codes used to report the professional and technical components of cytopathology that were inadvertently omitted in a previous communication.

According to CMS Transmittal 915, Change Request (CR) 7513, issued July 22, the following two CPT® codes are subject to CLIA edits, retroactively effective Jan. 1, 2011:
88120  Cytopathology, in situ hybridication (e.g., FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual
88121  Cytopathology, in situ hybridication (e.g., FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; using computer-assisted technology
The edits apply to Medicare Part B claims for both the professional (modifier 26 Professional component) and technical component (modifier TC Technical component) of laboratory services.

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