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Pathology/Lab Coding Alert

Reimbursement:

Find the Fee Schedule for Your ER/PR Pay

Published on Sun Sep 12, 2010

Professional and technical billing impact your bottom lineYou have five code choices for estrogen receptor (ER) and progesterone receptor (PR) tests -- but do you know where to look for payment and compliance information to ensure you're getting all the pay you deserve?Refer to "4 Steps Ensure That You Clear Every ER/PR Coding Hurdle" in Pathology/Lab Coding Alert Vol. 11 no. 9 for a refresher on choosing the proper code. Read on to learn how Medicare fee schedule and component billing will influence your ER/PR pay.Zero In on Clinical LabIf you're billing Medicare for one of the ER/PR assays, you'll look to the Clinical Laboratory Fee Schedule (CLFS) for pricing information. Here's the pay you can expect for the following codes based on the CLFS national limit amount:84233 (Receptor assay; estrogen) ($92.26)84234 (... progesterone) ($92.92)Medicare pays these on the CLFS because they're clinical laboratory tests. As such, they do not [...]
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