New HCPCS Codes Subject To or Excluded From CLIA Edits

New HCPCS Codes Subject To or Excluded From CLIA Edits

The Centers for Medicare & Medicaid Services (CMS) released a provider education article (MLN Matters® MM9035), January 30, to inform physicians and their support staff of retroactive changes to HCPCS Level II codes subject to, or excluded from, Clinical Laboratory Improvement Amendments (CLIA) edits.

Codes discontinued on December 31, 2014 are:

G0417-G0419, 80100-80104, 80152, 80154, 80160, 80166, 80172, 80174, 80182, 80196, 80440, 82000, 82003, 82055, 82101, 82145, 82205, 82520, 82646, 82649, 82651, 82654, 82666, 82690, 82742, 82953, 82975, 82980, 83008, 83055, 83071, 83634, 83805, 83840, 83858, 83866, 83887, 83925, 84022, 84127, 87001, 87620, 87621-87622, 88343, 88349

New codes subject to CLIA edits are:

G0464, G6030-G6058, 80163, 80165, 80300-80304, 80320-80377, 81246, 81288, 81313, 81410-81411, 81415-81417, 81420, 81425-81427, 81430-81431, 81435-81436, 81440, 81445, 81450, 81455, 81460, 81465, 81470-91471, 81519, 87505-87507, 83006, 87623-87625, 87806, 88341, 88344, 88364, 88366, 88369, 88373-88374, 88377

Excluded from CLIA edits is new code 89337 Cryopreservation, mature oocyte(s). This service was previously reported with Category III CPT® code 0059T, which is now deleted.

These changes are retroactively effective January 1, 2015. Medicare administrative contractors have until April 6, 2015 to implement these changes.

CMS also reminds providers in MM9035 that HCPCS Level II G0472 Hepatitis C antibody screening, for individual at high risk and other covered indication(s) is covered for services performed on or after June 2, 2014. This code is subject to CLIA edits.

Renee Dustman

Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman

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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

One Response to “New HCPCS Codes Subject To or Excluded From CLIA Edits”

  1. Adrienne Bernhard says:

    My primary care physician ordered a Hepatitis C screening test for me. I was born in 1948. The lab refused to do it because they said Medicare has been refusing to pay them when they do the test. Can you tell me exactly what codes should be used and/or any other information Medicare would need to reimburse for this screening? I’ve called Medicare and they just read from a manual and tell me I have to have a necessary medical condition to get this screening even though the Medicare.gov website and handbook state otherwise. Please help.

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