Organ Disease Panels Paid Under Clinical Lab Fee Schedule

The Centers for Medicare & Medicaid Services (CMS) is updating requirements regarding independent laboratory billing. The policy update applies to automated multi-channel chemistry (AMCC) organ disease panel tests for beneficiaries who are not receiving dialysis for treatment of end-stage renal disease (ESRD).

Effective for services on or after Jan. 1, 2012, independent labs will no longer be required to bill separately for each individual AMCC lab test included in organ disease panel codes (80047, 80048, 80051, 80053, 80061, 80069, and 80076). Organ disease panels will be paid under the Clinical Laboratory Fee Schedule and will not be subject to the 50/50 rule payment calculation.

Organ disease panel codes will be added to the list of bundled ESRD Perspective Payment System laboratory tests in January 2012. Normal bundling and duplicate editing rules that prevent suppliers from billing both the panel code and corresponding individual test codes for the same beneficiary on the same date of service will continue to apply.

For more information, refer to CMS Transmittal 939, Change Request (CR) 7497, issued Aug. 1, or the corresponding MLN Matters article.

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