Processing and Reporting of Organ- or Disease-oriented Lab Panels - Medicare-based Plans

Effective for services on and after January 1, 2018, HMSA's Medicare-based plans are reimbursed based on the revised Clinical Lab Fee Schedule containing the National Fee schedule rates.

When individual CPT laboratory tests are billed, no roll up or ATP paneling will be applied. We will continue to edit and apply NCCI bundling to ensure that if a CPT laboratory panel code is submitted and allowed, any additional individual CPT laboratory code(s) billed that are part of the same panel will not be allowed.

Source: CMS Transmittal R3740CP, CR9837

Revision History