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MIR-2007 04B, April 2007
MLN Matters. . .Information for Medicare Providers
(Issued by the Centers for Medicare & Medicaid Services)
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Correction to CR5404: New Waived Tests (MM5482)
Provider Types Affected
Physicians, providers, and suppliers submitting claims to Medicare carriers and/or Part A/B Medicare Administrative Contractors (A/B MAC) for services provided to Medicare beneficiaries
Provider Action Needed
Impact to You
Change Request (CR) 5482, from which this article is taken, corrects information provided in CR 5404 (released November 24, 2006).
What You Need to Know
CR 5404, which informed carriers and A/B MACS about new waived tests approved by the Food and Drug Administration (FDA) under Clinical Laboratory Improvement Amendments of 1988 (CLIA), contained an incorrect Current Procedural Terminology (CPT) code for the Gryphus Diagnostics BVBlue test. The correct code for this test is 87999QW (Unlisted microbiology procedure).
What You Need to Do
You should ensure that your billing staffs are made aware of this CPT code correction, and bill accordingly.
Background
CR 5404, which informed carriers and A/B MACS of new waived tests approved by the Food and Drug Administration (FDA) under the Clinical Improvement Amendments of 1988 (CLIA), contained an incorrect CPT for the Gryphus Diagnostics BVBlue test. In both the table in the background section of the Recurring Update Notification attachment and in the waived test list attachment, CR 5404 listed the CPT code for the Gryphus Diagnostics BVBlue as CPT Code: 87899QW.
The CPT code 87899 is for infectious agent activity detection tests by immunoassay with direct optical observation; not otherwise specified. In contrast, the Gryphus Diagnostics BVBlue test is an enzymeactivity test that detects sialidase activity in vaginal fluid specimens and is not an immunoassay test. The code in this table and in the waived test list attachment should have been 87999QW (Unlisted microbiology procedure). See the table below for the correct codes.
Note : All the other information in CR 5404 remains the same.
Table 1
CPT Codes for FDA Approved New Waived Tests
| CPT Code/ Modifier |
Effective Date |
Description |
82274QW, G0328QW |
June 15, 2006 |
Immunostics, Inc., hema-screen Specific Immunochemical Fecal Occult Blood Test |
87999QW |
June 30, 2006 |
Gryphus Diagnostics BVBlue |
83655QW |
September 18, 2006 |
ESA Biosciences LeadCare II Blood Lead Testing System (whole blood) |
You should remember that the CLIA regulations require a facility to be appropriately certified for each test performed, and that laboratory claims are currently edited at the CLIA certificate level.
Note: Carriers and A/B MACs will not search their files to correct affected claims processed prior to the implementation date of this change, but will adjust any claims that you bring to their attention.
Additional Information
You can find the official instruction, CR 5482, issued to your carrier or A/B MAC by visiting http://www.cms.hhs.gov/Transmittals/downloads/R1197CP.pdf  on the CMS Web site.
The MLN Matters article, MM5404, related to CR5404 may be found at http://www.cms.hhs.gov/MLNMAttersArticles/downloads/MM5404.pdf on the CMS Web site.
If you have any questions, please contact your carrier or A/B MAC at their toll-free number, which may be found at http://www.cms.hhs.gov/MLNProducts/downloads/CallCenterTollNumDirectory.zip  on the CMS Web site.
Flu Shot Reminder
It’s Not Too Late to Give and Get a Flu Shot!
The peak of flu season typically occurs between late December and March; however, flu season can last until May. Protect yourself, your patients, and your family and friends by getting and giving the flu shot. Each office visit presents an opportunity for you to talk with your patients about the importance of getting an annual flu shot and a lifetime pneumococcal vaccination. Remember - influenza and pneumococcal vaccination and their administration are covered Part B benefits. Note that influenza and pneumococcal vaccines are NOT Part D covered drugs. For more information about Medicare’s coverage of adult immunizations and educational resources, go to CMS’s Web site: http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0667.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: MM5482
Pub. 100-4, Transmittal# R1197CP, CR# 5482
Related CR Release Date: March 9, 2007
Effective Date: April 1, 2007
Implementation Date: April 2, 2007
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.
| CPT five-digit codes, descriptions, and other data only are copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS clauses apply. |
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