Forum - Questions & Answers

Apr 13th, 2015 - andyo1013

Substance Abuse Laboratory Testing

An insurer has taken the position that, for patients in in/outpatient treatment programs for which a per diem is paid (HCPCS Codes H0010-15), all laboratory testing (at the facility or at an independent reference lab) is covered in the per diem amount paid to the treatment program provider, and that the insurer will not pay the reference lab for the testing it conducted. The only source cited was a vague reference to one of the private HCPCS coding manuals.
CMS says that all laboratory testing should be "fee for service" under the Lab Fee Schedule.
Can anyone provide some information on this issue?
Thank you

Apr 14th, 2015 - Kat31477 56 

re: Substance Abuse Laboratory Testing

Many lab services became bundled effective Jan 1 2014. Check this link http://apsmedbill.com/newsletters/2014-02/laboratory-codes-bundled-opps-final-rule it provides the CMS transmittal number. Google that and you should be able to find the info you need.

Apr 14th, 2015 - Kat31477 56 

re: Substance Abuse Laboratory Testing

And here http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8572.pdf

scroll down to page 11



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