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2016 Lab Fee Schedule Updated     


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Laboratory Fee Schedule

2016
2015

Physician Fee Schedule

2016
2015

OPPS Fee Schedule

2016
2015

ASC Fee Schedule

2016
2015

APC Codes

2016
2015

ASP Drug Pricing Files





80053
Quick jump to procedure code: Printer Friendly Version
80061

CPT® 80055: OBSTETRIC PANEL THIS PANEL MUST INCLUDE THE FOLLOWING: BLOOD COUNT, COMPLETE (CBC), AUTOMATED AND AUTOMATED DIFFERENTIAL WBC COUNT (85025 OR 85027 AND 85004) OR BLOOD COUNT, COMPLETE (CBC), AUTOMATED (85027) AND APPROPRIATE MANUAL DIFFERENTIAL WBC COUNT (85007 OR 85009) HEPATITIS B SURFACE ANTIGEN (HBSAG) (87340) ANTIBODY, RUBELLA (86762) SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART) (86592) ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE (86850) BLOOD TYPING, ABO (86900) AND BLOOD TYPING, RH (D) (86901)

Short Description: Obstetric panel

--

CPT copyright 2015 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Marin/Napa/Solano
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Rest of North California
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-Rest of South California
COLORADO-Entire State
CONNECTICUT-Entire State
DELAWARE-Entire State
DIST of COL-DC + MD/VA Suburbs
FLORIDA-Ft Lauderdale
FLORIDA-Miami
FLORIDA-Rest of Florida
GEORGIA-Atlanta
GEORGIA-Rest of Georgia
HAWAII/GUAM-Entire State/Terr.
IDAHO-Entire State
ILLINOIS-East St. Louis
ILLINOIS-Suburban Chicago
ILLINOIS-Chicago
ILLINOIS-Rest of Illinois
INDIANA-Entire State
IOWA-Entire State
KANSAS-Entire State
KENTUCKY-Entire State
LOUISIANA-New Orleans
LOUISIANA-Rest of Louisiana
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MAINE-Rest of Maine
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MARYLAND-Rest of Maryland
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MASSACHUSETTS-Rest of Massachusetts
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TEXAS-Rest of Texas
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WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State
2016 Laboratory Fee Schedule: $65.12

Revenue Code(s):
301-Laboratory-chemistry



2016 OPPS Status Indicator: E

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

Commonly Associated Diagnosis Codes*            Hide this section.
Limited claims data available for this procedure.
PercentageICD-9ICD-10 Conversions
31.6% V22.1    Supervision of other normal pregnancy Z34.80   Encounter for supervision of other normal pregnancy, unspecified trimester
OR:
Z34.90   Encounter for supervision of normal pregnancy, unspecified, unspecified trimester
26.3% V22.2    Pregnant state, incidental Z33.1   Pregnant state, incidental
10.5% V73.81    Special screening examination, Human papillomavirus (HPV) Z11.51   Encounter for screening for human papillomavirus (HPV)
5.3% V74.5    Special screening examination for venereal disease Z11.3   Encounter for screening for infections with a predominantly sexual mode of transmission
5.3% V28.9    Unspecified antenatal screening Z36   Encounter for antenatal screening of mother
5.3% V22.0    Supervision of normal first pregnancy Z34.00   Encounter for supervision of normal first pregnancy, unspecified trimester
5.3% 646.93    Unspecified complication of pregnancy, antepartum condition or complication defects O99.89   Other specified diseases and conditions complicating pregnancy, childbirth and the puerperium
5.3% 493.90    Asthma, unspecified, unspecified J45.909   Unspecified asthma, uncomplicated
OR:
J45.998   Other asthma
5.3% 250.00    Diabetes mellitus without complication, type II or unspecified type, not stated as uncontrolled E11.9   Type 2 diabetes mellitus without complications

* Commonly Associated ICD-10 codes derived from 2010 Physician Supplier Part B Medicare claims data and 2015 CMS General Equivalency Mapping Codes (GEM).
This data represents an analysis of 43 million claims processed for 1.7 million beneficiaries in 2010.

Medicare Coverage Policy Information         Hide this section.
No contractor selected.

80055 not found in an Local Coverage Determination (LCD) for your contractor. No other coverage policies found in database.

CCI and MUE Edits*         Hide this section.


Medically Unlikely Edits for 80055

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: Not Listed Not Listed Not Listed
Adjudication Indicator: Not Listed Not Listed Not Listed
Rationale: Not Listed Not Listed Not Listed

* The responsibility for the content of any "National Correct Coding Policy" included in this product is with the Centers for Medicare and Medicaid Services and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, nonuse, or interpretation of information contained in this product.



   Medicare Part B Utilization Data for 80055*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 322
Total Services Denied 2014: 322 (100.0%)
National Charges Submitted 2014: $ 69,331.00
National Charges Allowed 2014: $ 0.00
National Average (No Modifier) Fee Submitted 2014: $182.66
National Average (No Modifier) Fee Allowed 2014: $ 0.00


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
276 85.7% $220.21 276 100.0%
Obstetrics/gynecology 31 9.6% $183.93 31 100.0%
Nurse practitioner 7 2.2% $238.14 7 100.0%
Family practice 5 1.6% $154.80 5 100.0%
Internal medicine 2 0.6% $164.50 2 100.0%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 277 86.0% $219.67 277 100.0%
Office 45 14.0% $188.64 45 100.0%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
GY 212 65.8% $236.24 212 100.0%
No Modifier 94 29.2% $182.72 94 100.0%
90 - Reference (Outside) Laboratory 12 3.7% $112.29 12 100.0%
GZ - Service Expected to be Denied as Not Reasonable and Necessary 4 1.2% $183.00 4 100.0%

Click here for more information on Custom CodeMap Medicare Utililation Reports.


*Utilization data is derived from analysis of the Physician Supplier Procedure Summary Master File (PSPSMF) which includes data from all Medicare Part B carriers. This data represents procedure-specific billing data for all physician/supplier services rendered to all Medicare beneficiaries during the calendar year named and processed by the Carriers through the six months of the following year.

Part B charge and utilization data for institutional services (hospital outpatient departments, home health agencies, comprehensive outpatient rehabilitation facilities, end-stage renal disease facilities, and rural health clinics) are processed by Medicare Part A fiscal intermediaries and are not included in this data. Data for services rendered to beneficiaries enrolled in risk-based Health Maintenance Organizations (HMOs) are also not included.


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06/28/2016 03:22:37 54.198.129.56

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