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Pathology/Lab Coding Alert

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Break Out Components for Evocative/Suppression Payment

Published on Fri Jan 07, 2011

Question: I've looked on the Clinical Laboratory Fee Schedule for pricing for Calcitonin stimulation panel, which our lab performs, but the payment values are $0. I noticed that all the codes in this range (80400-80440) show no payment -- doesn't Medicare cover these tests?Maryland SubscriberAnswer: Yes, Medicare may cover some of these tests when the provider demonstrates medical necessity. The absence of a payment rate on the Clinical Laboratory Fee Schedule (CLFS) doesn't indicate lack of coverage.The tests in the range you mention -- 80400-80440 are evocative/suppression tests. That means the lab takes a baseline test of some blood constituent, then the patient receives a dose of some compound to either evoke or suppress a response, which the lab measures with subsequent blood constituent testing. You'll notice that each lab code in the 80400-80440 range lists the individual tests that the lab must perform. For instance: You should report the test [...]
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