Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 1687 Date: February 20, 2009

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1 anual ystem Pub edicare laims Processing epartment of ealth & uman ervices () enters for edicare & edicaid ervices () Transmittal 1687 ate: ebruary 20, 2009 hange equest 6356 ubject: ealthcare ommon Procedure oding ystem (P) odes ubject to and xcluded from linical Laboratory mprovement mendments (L) dits. UY O NG: This change request will inform contractors about the new P codes, including modifiers, for 2009 that are both subject to L edits and excluded from L edits. The attached ecurring Update Notification applies to hapter 16, New / evised aterial ffective ate: January 1, 2009 mplementation ate: pril 6, 2009 isclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. ny other material was previously published and remains unchanged. owever, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.. NG N NUL NTUTON: (N/ if manual is not updated) =V, N=NW, =LT-Only One Per ow. /N/ hapter / ection / ubsection / Title N/. UNNG: TON : or iscal ntermediaries and arriers: No additional funding will be provided by ; ontractor activities are to be carried out within their operating budgets. TON B: or edicare dministrative ontractors (s): The edicare dministrative ontractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements. V. TTNT: ecurring Update Notification *Unless otherwise specified, the effective date is the date of service.

2 ttachment ecurring Update Notification Pub Transmittal: 1687 ate: ebruary 20, 2009 hange equest: 6356 UBJT: ealthcare ommon Procedure oding ystem (P) odes ubject to and xcluded from linical Laboratory mprovement mendments (L) dits ffective ate: January 1, 2009 mplementation ate: pril 6, GNL NOTON. Background: The linical Laboratory mprovement mendments (L) regulations require a facility to be appropriately certified for each test performed. To ensure that edicare & edicaid only pay for laboratory tests performed in certified facilities, each claim for a P code that is considered a L laboratory test is currently edited at the L certificate level. The P codes that are considered a laboratory test under L change each year. ontractors need to be informed about the new P codes that are both subject to L edits and excluded from L edits. The following P codes were discontinued on ecember 31, 2008: G0394 Blood occult test (e.g., guaiac), feces for single determination for colorectal neoplasm (i.e., patient was provided three cards or single triple card for consecutive collection), Bilirubin, total trancutaneous, 0026T Lipoprotein, direct measurement, intermediate density lipoprotein (L) (remnamt lipoproteins), and 0041T Urinalysis infectious agent detection, semi-quantitative analysis of volatile compounds. or 2009, the following new P codes are excluded from L edits and do not require a facility to have any L certificate: Bilirubin, total trancutaneous, emoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin, and emoglobin, quantitative, transcutaneous, per day; methemoglobin. The P codes listed in the chart that follows are new for 2009 and are subject to L edits. The list does not include new P codes for waived tests or provider-performed procedures. The P codes listed below require a facility to have either a L certificate of registration (certificate type code 9), a L certificate of compliance (certificate type code 1), or a L certificate of accreditation (certificate type code 3). facility without a valid, current, L certificate, with a current L certificate of waiver (certificate type code 2) or with a current L certificate for provider-performed microscopy procedures (certificate type code 4) must not be permitted to be paid for these tests.

3 P odifier escription yleoperoxidase (PO) Oncoprotein; des-gamma-carboxy-prothrombin (P) oagulation and fibrinolysis, functional activity, not otherwise specified (eg, T-13), each analyte nfectious agent enzymatic activity other than virus (eg, sialidase activity in vaginal fluid) B. Policy: The L regulations require a facility to be appropriately certified for each test performed. To ensure that edicare and edicaid only pay for laboratory tests in a facility with a valid, current L certificate, laboratory claims are currently edited at the L certificate level.. BUN QUNT Use hall" to denote a mandatory requirement Number equirement esponsibility (place an X in each applicable column) / B hared- ystem aintainers OT ontractors shall apply L edits to the P codes mentioned above as subject to L edits ontractors shall deny payment for a claim submitted with the P codes mentioned above as subject to L edits to a provider without valid current L certificate, with a L certificate of waiver (certificate type code 2), or with a L certificate for provider-performed microscopy procedures (certificate type code 4) ontractors shall return a claim as unprocessable if a L number is not submitted on claims by providers for the P mentioned above as subject to L edits ontractors need not search their files to either retract payment for claims already paid or to retroactively pay claims. owever, contractors shall adjust claims brought to their attention. V W

4 . POV UTON Number equirement esponsibility (place an X in each applicable column) / B hared- ystem aintainers OT provider education article related to this instruction will be available at es shortly after the is released. You will receive notification of the article release via the established "LN atters" listserv. ontractors shall post this article, or a direct link to this article, on their Web site and include information about it in a listserv message within one week of the availability of the provider education article. n addition, the provider education article shall be included in your next regularly scheduled bulletin. ontractors are free to supplement LN atters articles with localized information that would benefit their provider community in billing and administering the edicare program correctly. V W V. UPPOTNG NOTON. or any recommendations and supporting information associated with listed requirements, use the box below: Use "hould" to denote a recommendation. X-ef equirement Number None. ecommendations or other supporting information: B. or all other recommendations and supporting information, use the space below: N/

5 V. ONTT Pre-mplementation ontact(s): Kathy Todd (410) Post-mplementation ontact(s): Kathy Todd (410) V. UNNG. or iscal ntermediaries (s) and arriers: No additional funding will be provided by ; contractor activities are to be carried out within their operating budgets. B. or edicare dministrative ontractors (): The contractor is hereby advised that this constitutes technical direction as defined in your contract. does not construe this as a change to the tatement of Work (OW). The contractor is not obligated to incur costs in excess of the amounts specified in your contract unless and until specifically authorized by the ontracting Officer. f the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the ontracting Officer, in writing or by , and request formal directions regarding continued performance requirements.