Pathology/Lab Coding Alert

Question: Medicare requires participating providers to indicate on the claim form in Box 20 if a service was purchased from an outside lab and what the purchase amount is. My question is regarding our charge amount that we report in Box 24-F: Can this fee exceed that which is reported in Box 20, or does it have to equal or be of lesser value? How does this impact billing other payers for the same service since we can't have two separate fee schedules for Medicare and other payers?Codify ForumAnswer: There is no longer a "purchased diagnostic test" rule, according to CMS. Instead, you need to take into account an "anti-markup rule." A physician must check box 20 'yes' and enter a dollar amount only if the anti-markup rule applies to a particular claim. When a pathologist purchases the technical component (TC) from a hospital, the pathologist usually meets an exception [...]