Along with the host of other updates that have defined the new calendar year, laboratory codes have received a number of changes as well. Under the Clinical Laboratory Improvement Amendments, more commonly known as CLIA, several codes and their respective fees have updated to reflect the latest healthcare trends. In order to receive reimbursement for the updated laboratory tests, facilities must have either a CLIA certificate of compliance (type code 1), a CLIA certificate of accreditation (type code 3), or a CLIA certificate of registration (type code 9). Facilities that only have a CLIA certificate of waiver (type code 2) or a CLIA certificate for provider-performed microscopy procedures (type code 4) will not be eligible for the proper reimbursement.
Under this update, the following HCPCS codes were discontinued at the end of 2017:
- 83499: Hydroxyprogesterone, 20 (synthetic hormone) level
- 84061: Phosphatase (enzyme) level for forensic examination
- 86185: Immunologic analysis for detection of antigen
- 86243: Measurement of Fc receptor
- 86378: Migration inhibitory factor
- 86729: Lympho venereum antibody
- 86822: Lymphocyte culture primed
- 87277: Legionella micdadei ag if
- 87470: Bartonella dna dir probe
- 87477: Lyme dis dna quant
- 87515: Hepatitis b dna dir probe
- 88154: Cytopath c/v select
The update also included numerous several pages of additions that can be found here.
Additionally, the annual update for local clinical lab fees has been set at 1.10%. As of the beginning of 2018, this only applies to Pap smear tests, where the assigned payment will be either the local fee or the national limitation amount (NLA), whichever is lower. The national minimum payment amount for the year has been set at $14.65, or $14.49 multiplied by the 1.10% factor. This change will affect several HCPCS codes, including 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88164, 88165, 88166, 88167, 88174, 88175, G0123, G0143, G0144, G0145, G0147, G0148, Q0111, Q0115, and P3000.