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2016 Lab Fee Schedule Updated     


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84702
Quick jump to procedure code: Printer Friendly Version
84704

CPT® 84703: GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE

Short Description: Chorionic gonadotropin assay

--

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
MINNESOTA-Entire State
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
NORTH CAROLINA-Entire State
NORTH DAKOTA-Entire State
OHIO-Entire State
OKLAHOMA-Entire State
OREGON-Portland
OREGON-Rest of Oregon
PENNSYLVANIA-Philadelphia
PENNSYLVANIA-Rest of Pennsylvania
PUERTO RICO-Entire Territory
RHODE ISLAND-Entire State
SOUTH CAROLINA-Entire State
SOUTH DAKOTA-Entire State
TENNESSEE-Entire State
TEXAS-Brazoria
TEXAS-Dallas
TEXAS-Galveston
TEXAS-Houston
TEXAS-Beaumont
TEXAS-Fort Worth
TEXAS-Austin
TEXAS-Rest of Texas
UTAH-Entire State
VERMONT-Entire State
VIRGIN ISLANDS-Entire State
VIRGINIA-Entire State
WASHINGTON-Seattle (King County)
WASHINGTON-Rest of Washington
WEST VIRGINIA-Entire State
WISCONSIN-Entire State
WYOMING-Entire State
2016 Laboratory Fee Schedule: $10.24

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
11.0% 626.0    Absence of menstruation N91.2   Amenorrhea, unspecified
4.6% V72.40    Pregnancy examination or test, pregnancy unconfirmed Z32.00   Encounter for pregnancy test, result unknown
4.4% V72.84    Preoperative examination, unspecified Z01.812   Encounter for preprocedural laboratory examination
OR:
Z01.818   Encounter for other preprocedural examination
3.4% 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
2.6% 626.4    Irregular menstrual cycle N92.5   Other specified irregular menstruation
OR:
N92.6   Irregular menstruation, unspecified
2.4% 789.00    Abdominal pain, unspecified site R10.9   Unspecified abdominal pain
2.2% V72.41    Pregnancy examination or test, negative result Z32.02   Encounter for pregnancy test, result negative
2.0% 304.00    Opioid type dependence, unspecified F11.20   Opioid dependence, uncomplicated
1.6% 295.70    Schizophrenic disorders, Schizoaffective disorder, unspecified F25.9   Schizoaffective disorder, unspecified
1.4% 626.8    Other disorders of menstruation N92.5   Other specified irregular menstruation
OR:
N93.8   Other specified abnormal uterine and vaginal bleeding

* 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.

84703 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 84703

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.


   84703 Top 5 Ordering Providers National*
RICARDO SINENSE -MILWAUKEE,WI 111
VICTOR LEE -FULLERTON,CA 92
TED EDWARDS -HUNTSVILLE,AL 75
LAURA CAMBRON -HUNTSVILLE,AL 53
MATTHEW PRICE -MURRAY,KY 51

   84703 Top 5 Ordering Organizations National*
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 709
LABORATORY CORPORATION OF AMERICA HOLDINGS-NC 571
UNILAB CORPORATION-CA 362
LABORATORY CORPORATION OF AMERICA HOLDINGS-OH 344
QUEST DIAGNOSTICS CLINICAL LABORATORIES INC-FL 318

*Based on 2014 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 84703*         Hide this section.


Annual Procedures / Tests Performed / Denied


Total National Services (all modifiers) Submitted 2014: 21,825
Total Services Denied 2014: 4,584 (21.0%)
National Charges Submitted 2014: $ 1,167,648.00
National Charges Allowed 2014: $ 174,275.00
National Average (No Modifier) Fee Submitted 2014: $ 55.70
National Average (No Modifier) Fee Allowed 2014: $ 10.13
National Average (26) Fee Submitted 2014: $ 16.33
National Average (26) Fee Allowed 2014: $ 0.00
National Average (QW) Fee Submitted 2014: $ 32.43
National Average (QW) Fee Allowed 2014: $ 9.91


Top 5 Performing Specialties 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
14,481 66.4% $ 62.98 2,495 17.2%
Family practice 1,924 8.8% $ 35.07 498 25.9%
Obstetrics/gynecology 1,585 7.3% $ 35.65 511 32.2%
Nurse practitioner 768 3.5% $ 36.17 234 30.5%
Internal medicine 763 3.5% $ 33.67 172 22.5%

Top 5 Places of Service 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 14,122 64.7% $ 63.91 2,455 17.4%
Office 6,973 31.9% $ 35.88 1,794 25.7%
Nursing facility 242 1.1% $ 15.17 23 9.5%
Urgent Care Facility (eff. 1/1/03) 200 0.9% $ 31.87 81 40.5%
Inpatient hospital 118 0.5% $ 9.33 118 100.0%

Top 5 Modifiers Submitted 2014 Total Tests Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 18,707 85.7% $ 55.70 3,895 20.8%
QW - CLIA Waived Category Test 2,103 9.6% $ 32.44 471 22.4%
90 - Reference (Outside) Laboratory 582 2.7% $ 68.38 110 18.9%
GA - Advanced Beneficiary Notice (ABN) on File 165 0.8% $ 51.39 35 21.2%
Q4 160 0.7% $ 28.09 19 11.9%

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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06/26/2016 10:19:31 107.22.22.71

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