2025 Medicare Reimbursement Information
 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."
Coding guidance based on the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services and the 2024 NCCI Policy Manual for Medicaid Services. NCCI Manual 2024 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."
*Use modifier QW to indicate a CLIA waived laboratory test. LOINC
SNOMED CT
1Medicare Reimbursement Amount does not reflect 2% Sequestration adjustment. Click here for more information. This information is provided as a convenience by CodeMap®. The information provided is for general educational purposes only and may not be conclusive or exhaustive. CodeMap® makes no representation, warranty, or guarantee that this compilation of information is error-free or that the use of this information will result in coverage and subsequent payment of claims. Recent changes in applicable law, regulations and interpretations may not be reflected in the information contained herein. While every effort is made to ensure that all information is current and complete, it is the responsibility of each user to verify specific coverage and payment information with their Medicare/Medicaid contractor. For technical questions, please contact CodeMap 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. CPT copyright 2024 American Medical Association. All rights reserved. |