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82272
Quick jump to procedure code: Printer Friendly Version
82286

CPT® 82274: BLOOD, OCCULT, BY FECAL HEMOGLOBIN DETERMINATION BY IMMUNOASSAY, QUALITATIVE, FECES, 1-3 SIMULTANEOUS DETERMINATIONS

Short Description: Assay test for blood fecal

--

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
MAINE-Southern Maine
MAINE-Rest of Maine
MARYLAND-Baltimore and suburbs
MARYLAND-Rest of Maryland
MASSACHUSETTS-Boston
MASSACHUSETTS-Rest of Massachusetts
MICHIGAN-Detroit
MICHIGAN-Rest of Michigan
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MISSISSIPPI-Entire State
MISSOURI-Kansas City
MISSOURI-St. Louis
MISSOURI-Rest of Missouri
MONTANA-Entire State
NEBRASKA-Entire State
NEVADA-Entire State
NEW HAMPSHIRE-Entire State
NEW JERSEY-Northern NJ
NEW JERSEY-Rest of New Jersey
NEW MEXICO-Entire State
NEW YORK-Manhattan
NEW YORK-NYC Suburbs/LI
NEW YORK-Poughkpsie/No NYC Sub
NEW YORK-Rest of New York
NEW YORK-Queens
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NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
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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: $21.67

Revenue Code(s):
301-Laboratory-chemistry



2016 OPPS Status Indicator: Q4

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.
PercentageICD-9ICD-10 Conversions
13.6% V76.51    Special screening for malignant neoplasms, colon Z12.11   Encounter for screening for malignant neoplasm of colon
9.0% V76.41    Special screening for malignant neoplasms, rectum Z12.12   Encounter for screening for malignant neoplasm of rectum
7.9% 285.9    Anemia, unspecified D64.9   Anemia, unspecified
3.9% 578.1    Blood in stool K92.1   Melena
3.0% V70.0    Routine general medical examination at a health care facility Z00.00   Encounter for general adult medical examination without abnormal findings
2.9% V58.69    Long-term (current) use of other medications Z79.891   Long term (current) use of opiate analgesic
OR:
Z79.899   Other long term (current) drug therapy
2.3% 787.91    Diarrhea K52.2   Allergic and dietetic gastroenteritis and colitis
OR:
K52.89   Other specified noninfective gastroenteritis and colitis
OR:
R19.7   Diarrhea, unspecified
2.2% 792.1    Other nonspecific findings on examination of stool contents R19.5   Other fecal abnormalities
2.1% 272.4    Other and unspecified hyperlipidemia E78.4   Other hyperlipidemia
OR:
E78.5   Hyperlipidemia, unspecified
1.8% 780.79    Other malaise and fatigue G93.3   Postviral fatigue syndrome
OR:
R53.1   Weakness
OR:
R53.81   Other malaise
OR:
R53.83   Other fatigue

* 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.

82274 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.

CCI Edits for 82274
Denied Codes (1) Effective Modifier
Accepted (2)
81528 Oncology colorectal scr 01/01/2016 No
82270 Occult blood feces 04/01/2002 No
82272 Occult bld feces 1-3 tests 01/01/2006 Yes
83026 Hemoglobin copper sulfate 04/01/2002 Yes
G0328 Fecal blood scrn immunoassay 07/01/2004 No
(1) These codes will be denied when submitted for payment on the same date of service as 81528.

(2) "Yes" indicates that the use of a modifier with the denied code will overcome the edit and allow payment.
"No" indicates that the second code will always be denied.


Medically Unlikely Edits for 82274

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 3 Date of Service Edit: Clinical 3 Date of Service Edit: Clinical Not Listed
Rationale: Nature of Analyte Nature of Analyte 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.


   82274 Top 5 Ordering Providers National*
JON KELLER -PALO ALTO,CA 1,409
BRUCE WALLER -INDIANAPOLIS,IN 1,204
FREDRICK NAYLOR -VISALIA,CA 1,014
VICTOR LEE -FULLERTON,CA 611
HEW QUON -LOS ANGELES,CA 540

   82274 Top 5 Ordering Organizations National*
LABORATORY CORPORATION OF AMERICA-CA 16,783
UNILAB CORPORATION-CA 12,338
UNILAB CORPORATION-CA 11,433
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 10,620
UNILAB CORPORATION-CA 8,792

*Based on 2013 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 82274*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 557,894
Total Services Denied 2014: 120,658 (21.6%)
National Charges Submitted 2014: $ 35,386,268.00
National Charges Allowed 2014: $ 9,268,300.00
National Average (No Modifier) Fee Submitted 2014: $ 71.37
National Average (No Modifier) Fee Allowed 2014: $ 21.24
National Average (QW) Fee Submitted 2014: $ 44.71
National Average (QW) Fee Allowed 2014: $ 21.05


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
291,287 52.2% $ 80.93 63,726 21.9%
Internal medicine 89,959 16.1% $ 43.61 17,213 19.1%
Family practice 82,066 14.7% $ 42.12 20,654 25.2%
Obstetrics/gynecology 40,953 7.3% $ 43.07 9,119 22.3%
Gastroenterology 20,150 3.6% $ 49.02 2,311 11.5%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 290,794 52.1% $ 80.53 63,696 21.9%
Office 264,205 47.4% $ 44.85 55,670 21.1%
Federally qualified health centers (eff. 10/1/93) 551 0.1% $ 59.46 170 30.9%
Outpatient hospital 317 0.1% $ 36.38 155 48.9%
Nursing facility 307 0.1% $ 40.22 84 27.4%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 365,546 65.5% $ 71.38 89,127 24.4%
QW - CLIA Waived Category Test 163,464 29.3% $ 44.71 24,572 15.0%
90 - Reference (Outside) Laboratory 14,071 2.5% $ 82.71 3,108 22.1%
GA - Advanced Beneficiary Notice (ABN) on File 7,424 1.3% $ 41.72 1,025 13.8%
Q4 2,736 0.5% $ 57.17 499 18.2%

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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05/04/2016 06:02:53 107.20.37.212

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