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MIR-2006-10AB, October 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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MMA - Independent Laboratory Billing for the Technical Component (TC) of Physician Pathology Services
Provider Types Affected
Independent laboratories that bill Medicare carriers
Impact of CR5210 on Independent Laboratories
Independent laboratories may not bill for the Technical Component (TC) of physician pathology services furnished to a patient of a hospital after December 31, 2006.
Background
In CR5210, the Centers for Medicare & Medicaid Services (CMS) proposes to implement the 1999 final physician fee schedule regulations (at 42 CFR § 415.130).
Prior to this proposal, any independent laboratory could bill the carrier under the physician fee schedule for the TC of physician pathology services for hospital inpatients. |
Section 732 of the Medicare Modernization Act (MMA) extended, for 2005 and 2006, the provision of Section 542 of the Benefits Improvement Act of 2000 (BIPA) that allowed certain independent laboratories to bill under the physician fee schedule for the technical component of physician pathology services furnished to patients of a covered hospital.
CR5210 instructs Medicare carriers to notify all independent laboratories that they may no longer bill for these services after the MMA provision expires on December 31, 2006.
Implementation
The implementation date for this instruction is December 1, 2006.
Additional Information
To review the related article that extended the provision of Section 542 of the Benefits Improvement Protection Act of 2000 (BIPA) for services furnished in 2005 and 2006, go to http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3467.pdf  on the CMS Web site.
The official instructions, CR 5210, issued to your Medicare carrier regarding this change, can be found at http://www.cms.hhs.gov/Transmittals/downloads/R1046CP.pdf on the CMS Web site.
If you have questions, please contact your Medicare carrier at their toll-free number which may be found at: http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
MLN Matters Number: MM5210
Pub. 100-4, Transmittal# R1046CP, CR# 5210
Related CR Release Date: September 1, 2006
Effective Date: December 1, 2006
Implementation Date: December 1, 2006
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