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MIR-2006-8AB, August 2006
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Healthcare Common Procedure Coding System (HCPCS) Correction for the Caffeine Halothane Contracture Test for Malignant Hyperthermia Susceptibility
Provider Types Affected
Providers billing Medicare carriers for laboratory tests
Provider Action Needed
Impact to You
Effective January 1, 2006, you do not have to include a Clinical Laboratory Improvement Amendments (CLIA) number on claims that you submit for HCPCS code 89049 [Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and report].
What You Need to Know
CR5113 provides that HCPCS code 89049 is not considered a test under CLIA. Therefore, performing this test does not necessitate that a facility have any CLIA certificate, nor require a CLIA number on claims for its use.
What You Need to Do
Make sure that your billing staffs are aware that they do not have to include a CLIA number on claims for HCPCS code 89049.
Background
The CLIA regulations require a facility to be appropriately certified for each test that it performs. Therefore, laboratory claims are currently edited at the CLIA certificate level to ensure that Medicare and Medicaid only pay for laboratory tests that are performed in facilities with valid, current CLIA certificates.
This being said, CR5113, from which this article is taken, notifies carriers of one HCPCS correction for code 89049 [Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and report]. While currently, HCPCS code 89049 is subject to CLIA edits and has a laboratory certification (LC) code of 610 (histopathology), CR 5113 provides that this HCPCS code is not considered a test under CLIA.
Therefore, effective January 1, 2006, carriers will remove CLIA edits for HCPCS code 89049, including the LC code 610, and will not require a CLIA number on claims submitted by facilities for the HCPCS code 89049.
You should be aware that your carriers are not required to search their files to either retract payment or retroactively pay claims processed before this change is made. However, they will adjust claims brought to their attention.
Additional Information
You can find more information about billing for HCPCS code 89049 [Caffeine halothane contracture test (CHCT) for malignant hyperthermia susceptibility, including interpretation and report] by going to CR5113, located at http://www.cms.hhs.gov/Transmittals/downloads/R984CP.pdf  on the CMS Web site.
If you have any questions, please contact your carrier at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.pdf .
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: MM5113
Pub. 100-4, Transmittal# R984CP, CR# 5113
Related CR Release Date: June 16, 2006
Effective Date: January 1, 2006
Implementation Date: October 2, 2006
Do you have your NPI? National Provider Identifiers (NPIs) will be required on claims sent on or after May 23, 2007. Every health care provider needs to get an NPI. Learn more about the NPI and how to apply for an NPI by visiting http://www.cms.hhs.gov/NationalProvIdentStand/  on the CMS Web site.
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