Molecular Diagnostics at Abbott


The information contained in this website has been compiled by CodeMap, L.L.C. to assist Abbott customers. 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. For technical questions, please contact CodeMap.

For other questions, please contact the Abbott Reimbursement Helpline at (800) 553-7042, option 6.


Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Changes

No payment adjustment through March 31, 2022
1% payment adjustment April 1 - June 30, 2022
2% payment adjustment beginning July 1, 2022
Source




      FISH
            AneuVysion®
      RealTime PCR
            RealTime CT/NG
            RealTime CMV
            RealTime HBV
            RealTime HCV
            RealTime HCV Genotype II
            RealTime HIV-1
            RealTime SARS-CoV-2

      Sequencing
            ViroSeq HIV-1 Genotyping System

      Alinity m
            Alinity m CMV Assay
            Alinity m HBV Assay
            Alinity m HCV Assay
            Alinity m HIV Assay
            Alinity m Resp-4-Plex
            Alinity m SARS-CoV2 Assay
            Alinity m STI Assay

      FISH
            PathVysion® HER-2 DNA Probe Kit
            UroVysion®
            Vysis ALK Break Apart FISH Probes Kit
            Vysis CLL FISH Probe Kit
            Vysis EGR1 FISH Probes Kit

      RealTime PCR
            RealTime IDH1®
            RealTime IDH2®
RealTime CT/NG

U.S. Medicare Part B Reimbursement for
Fees Reflect 2022 CMS Medicare Fee Schedules

RealTime CT/NG

Providers should be aware of information relevant to the coding for this test that has been included in the National Correct Coding Initiative (NCCI) Policy Manual. The NCCI Policy Manual is used by Medicare Administrative Contractors (MACs) as a general reference tool that explains the rationale for NCCI edits. This test is an example of a single laboratory procedure which produces multiple reportable test results, and using the NCCI introductory language as guidance conflicts with the AMA guidance to code laboratory procedures at the highest level of specificity. More information on this topic can be found here: https://www.aacc.org/advocacy-and-outreach/comment-letters/2021/ncci-stakeholder-letter

In this situation, providers must choose which guidance to follow; the NCCI manual or long-standing AMA guidance included in the CPT manual and supporting materials. Either approach may present potential compliance issues that should be discussed with laboratory management and legal/compliance departments. Seeking written guidance from both federally funded and private payers may offer further assistance.

Coding guidance based on CPT 2022 Professional Edition p. 679
"When separate results are reported for different species or strain of organisms, each result should be coded separately."

Product Name
Procedure Code
Procedure Description
Reimbursement Amount
CT
87491
  CCI   MUE   NCD
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique
$ 35.09
NG
87591
  CCI   MUE   NCD
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique
$ 35.09



Coding guidance based on the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services and the 2022 NCCI Policy Manual for Medicaid Services.

NCCI Manual 2022 Ch.10, Section M.15 (pp. X-19)

"15. In the case of tests for infectious agents, methodologies include detection by immunofluorescence, immunoassay, or nucleic acid probe techniques. A single laboratory procedure shall be reported as one unit of service whether it generates one or multiple results. CPT codes that test for a single infectious agent that employ one procedure, one methodology, or one test kit are reported with one unit of service.

CPT codes that test for multiple infectious agents are reported with one unit of service if one procedure, one methodology, or one test kit is used to perform the test (e.g., 87300, 87451, 87800, 87801). When multiple procedures, multiple methodologies, or multiple kits are medically necessary and used to perform a test for multiple infectious agents, the units of service reported for CPT codes that identify multiple infectious agents equals the number of different procedures, methodologies, or kits used to perform the test.

For example, if a provider/supplier tests for 5 different species of an infectious agent using a single multiple-result test kit, only 1 unit of service for that test kit may be reported. However, if a provider/supplier tests for 3 different species of an infectious agent by using 3 different single result test kits, the provider/supplier may report 3 UOS of the appropriate CPT code."


Product Name
Procedure Code
Procedure Description
Reimbursement Amount
CT/NG Combo Test
87801
  CCI   MUE  
Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique
$ 70.20



LOINC Codes-Updated 06/13/2022

Under the MolDx program, certain molecular tests require a Z-Code(TM) identifier in addition to the appropriate CPT code. Services within the scope of this program require the Z-Code(TM) to be submitted as additional information at the time of claim submission in order to be fully adjudicated. Laboratories performing these molecular tests may be required to register with the MolDx program for each molecular pathology test they furnish. For more information on the MolDx program, registration and covered procedures, please click here: https://www.palmettogba.com/palmetto/MolDX.nsf

The information contained in this website has been compiled by CodeMap, L.L.C. to assist Abbott customers in preparing and submitting claims to Federal health care programs 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 assumes no responsibility for omissions or errors contained in this website. Abbott does not guarantee that the use of any information provided herein will result in coverage or payment by Federal health care programs at any particular level. Many factors affect Federal health care program reimbursement, not all of which may be described in the information provided. Website users are encouraged to seek individual legal and/or coding guidance. IN PROVIDING THIS WEBSITE, ABBOTT 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 is not responsible for any actions taken by website users in billing Medicare or Medicaid for Abbott 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 and should check with the individual Federal health care program contractors to verify coverage, coding and payment. As a courtesy to its customers, Abbott provides the most accurate and up-to-date information available, but it is subject to change and interpretation. The customer is ultimately responsible for determining the appropriate codes, coverage, and payment policies for individual patients. Abbott does not guarantee third party coverage or payment for our products or reimburse customers for claims that are denied by third party payors.

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. © 2022 Abbott. All rights reserved. All trademarks referenced are trademarks of either the Abbott group of companies or their respective owners.

CPT copyright 2021 American Medical Association. All rights reserved.

06/26/2022 02:27:51