MLN Matters Number: MM5987                                            Related Change Request (CR) #: 5987
Related CR Release Date: April 11, 2008                                 Effective Date: April 1, 2008
Related CR Transmittal #: R331OTN                                       Implementation Date: May 12, 2008

Clinical Laboratory Fee Schedule - Implementation of Section 113 Medicare, Medicaid, and State Children’s Health Insurance Program (MMSCHIP) Legislation

Provider Types Affected
Clinical laboratories billing Medicare contractors (carriers, fiscal intermediaries, or Part A/B Medicare Administrative Contractors (A/B MAC)) for services to Medicare beneficiaries

Provider Action Needed
This article is based on Change Request (CR) 5987 which alerts clinical laboratories that, effective for tests furnished on or after April 1, 2008, the MMSCHIP Extension Act of 2007 sets payment for code 83037 and 83037QW (Hemoglobin; glycosylated (A1c) by device) by crosswalking it to be the same as 83036 (glycosylated (A1c)). Make certain your billing staffs are aware of this change.

Background
The MMSCHIP Extension Act of 2007 passed in December 2007 and included Section 113. Section 113 of the legislation set the price for any diagnostic test HbA1C that is labeled by the Food and Drug Administration (FDA) for home use equal to the payment rate for a glycated hemoglobin test (identified as of October 1, 2007, by Healthcare Common Procedure Coding System (HCPCS) code 83036 (and any succeeding codes)). The legislation is effective for tests furnished on or after April 1, 2008.

• For Calendar Year (CY) 2006, the Current Procedural Terminology (CPT) established new code 83037 (Hemoglobin; glycosylated (A1c) by device cleared by the FDA for home use). CPT code 83036 (glycosylated (A1c)), already existed and was priced at $13.56 on the clinical laboratory fee schedule.
• For calendar year 2006, CMS determined that code 83037 should be paid via carrier gap filling.
• For calendar year 2007, CMS set the payment for code 83037 by crosswalking it to code 82985 (Glycated protein).
• For tests furnished on or after April 1, 2008, the payment for 83037 or 83037QW will be the same as the payment on the clinical laboratory fee schedule for 83036.

Your Medicare contractor will adjust claims for services on or after April 1, 2008, processed prior to implementation of this change if you bring such claims to the contractor’s attention.

Additional Information
To see the official instruction (CR5987) issued to your Medicare contractor visit http://www.cms.hhs.gov/Transmittals/downloads/R331OTN.pdf on the CMS Web site.
If you have questions, please contact your Medicare contractor 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. CPT only copyright 2007 American Medical Association.

News Flash – The Clinical Laboratory Fee Schedule Fact Sheet, which provides general information about the Clinical Laboratory Fee Schedule, coverage of clinical laboratory services, and how payment rates are set, is now available in downloadable format from the Centers for Medicare & Medicaid Services Medicare Learning Network at http://www.cms.hhs.gov/MLNProducts/downloads/clinical_lab_fee_schedule_fact_sheet.pdf on the CMS Web site.

Posted: 04/23/2008