New Waived Tests Payable Under Medicare

Certified facilities performing laboratory tests should be aware of a recent update to the list of codes subject to or excluded from Clinical Laboratory Improvement Amendments (CLIA) edits.

New codes subject to CLIA edits and payable under Medicare are shown in the table below.

Code Effective date Description
G0434QW April 22, 2011 Diagnostic test group clarity multiple drug screen cups
87804QW Dec. 9, 2011 BD Veritor System for rapid detection of flu A+B (For use with nasal and nasopharyngeal swabs) {includes a reader}
G0434QW Dec. 14, 2011 Alere Toxicology Services Alere iCassette DX Drug Screen
82055QW Jan. 6, 2012 Jant Pharmacal Corporation Accustrip Saliva Alcohol Test Strip
83861QW Jan. 23, 2012 TearLab Corporation TearLab Osmolarity System
G0434QW Jan. 26, 2012 Alere iCassette drug screen
87804QW Jan. 27, 2012 Alere influenza A & B test (for use with nasal swabs only)
87808QW Feb. 3, 2012 Sekisui Diagnostics, LLC OSOM Trichomonas Rapid Test
87880QW March 1, 2012 Sekisui Diagnostics, LLC OSOM Strep A Test {direct from throat swab}
86386QW Jan. 1, 2012 Nuclear matrix protein 22 (NMP22), qualitative
87389QW Jan. 1, 2012 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result
0279T Jan. 1, 2012 Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood);
0280T Jan. 1, 2012 Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); interpretation and report

CPT® 2012 added 101 new codes for molecular pathology (81200-81408) that are subject to CLIA edits; however, these codes are not payable under Medicare.

Effective Jan. 1, 2012, CPT® codes 88107 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and filter preparation with interpretation and 88318 Determinative histochemistry to identify chemical components (e.g., copper, zinc) have been discontinued. (To report smears and simple filter preparation, see 88104 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation or 88106 Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation. For determinative histochemistry to identify chemical components, use 88313 Group II, all other (e.g., iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunoperoxidase.)

The Centers for Medicare & Medicaid Services (CMS) notified contractors of these changes on April 6, in Transmittal 2441. Contractors are to implement these changes by July 2, 2012. Contractors are not required to search their files to either retract or pay claims already submitted, but are instructed by CMS to adjust claims brought to their attention.

For more information, see CMS Transmittal 2439 and MLN Matters® articles MM7795, MM7766.

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