The information on this site is provided by CodeMapĀ©. For any questions, please contact Dr. Charles Root at charlesroot@codemap.com

This website is a private website and is not associated, endorsed or authorized by the Department of Health and Human Services, the Center for Medicare and Medicaid Services or any other public or government organization or agency.

National
2017 Laboratory Fee Schedule

Effective April 1, 2013 and while sequestration is in effect, all CMS payments for services will be reduced by 2%.
The fees below do not reflect this reduction. Click here for more information.



Disclaimer How To Use This Web Site Advance Beneficiary Notices Frequently Asked Questions
Index:

  • Blood Gases
  • Chemistry
  • Coagulation
  • Cardiac Markers
  • Pregnancy
  • Piccolo-Tests Performed by Waived Laboratories
  • Piccolo-Tests Performed by CLIA Moderate Complexity Laboratories
  • When and how should I use an Advance Beneficiary Notice (ABN) when running iSTAT tests?

    When a Medicare carrier is likely to deny payment because of medical necessity policy (for example, when the diagnosis is not covered by national or local policy, a frequency limit applies) the patient must be informed and consent to pay for the service before it is performed, or they have no obligation to pay for the test.

    An Advance Beneficiary Notice or ABN is used to document that the patient is aware that Medicare may not pay for a test and has agreed to pay the provider in the event payment is denied. Each ABN must be specific to the service provided and the reason that Medicare may not pay for the service. Blanket waivers for all Medicare patients are not allowed.

    An ABN must:

    (1) be in writing;

    (2) be obtained prior to the beneficiary receiving the service;

    (3) clearly identify the particular service;

    (4) state that the provider believes Medicare is likely to deny payment for the specific service;

    (5) give the reason(s) that the provider believes that Medicare is likely to deny payment for the specific service; and

    (6) include the beneficiary's signature and date.

    Routine notices to beneficiaries that do nothing more than state that Medicare denial of payment is possible, or that the provider does not know whether Medicare will pay for a service, will not be considered acceptable evidence of advance notice. Unacceptable practices include:

    (1) giving notice for all claims or services;

    (2) failing to list the specific reason or rationale for likely denial;

    (3) failing to state the particular test or service that Medicare is likely to deny.

    However, providers may routinely provide ABNs is when the frequency of the test is restricted by either a national coverage decision or a local medical review policy. In this situation, a provider may provider an ABN almost every time the test is performed because the provider has no idea how often the procedure has been performed for the beneficiary in the past.

    The CPT code modifier, -GA (Waiver of Liability Statement on File), must be used to indicate that the provider has notified the Medicare patient that the test performed may not be reimbursed by Medicare and may be billed to the patient.

    A standard CMS ABN form must be used. CMS form No. CMS-R-131-L is specific for laboratory use. CMS form No. CMS-R-131-G is for general use. These forms are available on the CMS website at http://www.cms.hhs.gov/medicare/bni. The forms may be printed on the back of laboratory requisitions, but must be single sided and may not be otherwise modified except for the customizable boxes.

    Completing an effective ABN:

    Both ABNs have customizable boxes that may be preprinted with check-off items. The laboratory version contains three boxes:

    The first box is used to select or list a specific test that is not covered because of local or national coverage policy.

    The second box is used to select or list a test that may be denied based on frequency limits.

    The third box is used to identify research only or experimental tests that probably will not be covered. A list of tests can be preprinted in each box and selected as appropriate.

    The Estimated Cost item is optional, lack of an entry or a value different from the actual cost billed to the patient does not invalidate the ABN.

    At least two copies of the ABN are required; the provider retains the original and gives a copy to the patient.

    A signature is not required so long as proof exists that the beneficiary was notified that Medicare might not pay for a service or otherwise knew that payment might be denied.

    If a beneficiary refuses to sign an ABN, but demands that the service be provided, a witness can make a note to this effect and sign the ABN. The beneficiary will then be responsible for the service if it is subsequently denied.

    A patient must be notified far enough in advance to make a rational decision, without undue pressure, as to whether they want a test or service and are willing to pay for it. Patients should be given an ABN before they are prepped for a procedure or otherwise put in a position where they feel they cannot reasonably refuse treatment. ABNs should never be given to trauma patients or in any EMTALA situation. ABNs given to patients under great duress are not valid.

    When Medicare denies a service for which an ABN is on file, Medicare does not limit the amount the provider can collect from the patient. However, billing a very low amount (for example, significantly below what Medicare would pay) might be considered an inducement and implicate violation of the anti-kickback law.


    The information contained in this website has been compiled by CodeMap, L.L.C. to assist Abbott Point of Care customers in preparing and submitting claims to Medicare and CodeMap, L.L.C. remains solely responsible for its content. The information provided is for general educational purposes only and may not be conclusive or exhaustive. Recent changes in applicable law, regulations and interpretations may not be reflected in the information contained herein.

    Abbott Point of Care assumes no responsibility for omissions or errors contained in this website. Abbott Point of Care does not guarantee that the use of any information provided herein will result in coverage or payment by Medicare at any particular level. Many factors affect Medicare reimbursement, not all of which may be described in the information provided. Website users are encouraged to seek individual legal and/or billing guidance. IN PROVIDING THIS WEBSITE, ABBOTT POINT OF CARE MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, INCLUDING, BUT NOT LIMITED TO, WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND/OR NON-INFRINGEMENT.

    Abbott Point of Care is not responsible for any actions taken by website users in billing Medicare for Abbott Point of Care products, equipment or devices, including but not limited to, any billing and/or coding errors. Website users rely on the information contained in this website at their own risk.

    This website is a private website and is not associated, endorsed or authorized by the Department of Health and Human Services, the Center for Medicare and Medicaid Services or any other public or government organization or agency.