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CMS Transmittals




87339
Quick jump to procedure code: Printer Friendly Version
87341

Procedure Category: Pathology and Laboratory
Procedure Subcategory: Microbiology

87340: HEPATITIS B SURFACE AG IA

CPT® 87340: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg)




See also: Medicare Preventative Services




--

CPT copyright 2018 American Medical Association. All rights reserved.


Medicare Reimbursement Information         Hide this section.

Unadjusted-National Fee Schedule Amount
ALABAMA-Entire State
ALASKA-Entire State
ARIZONA-Entire State
ARKANSAS-Entire State
CALIFORNIA NORTH-Napa
CALIFORNIA NORTH-San Francisco
CALIFORNIA NORTH-San Mateo
CALIFORNIA NORTH-Oakland/Berkeley
CALIFORNIA NORTH-Santa Clara
CALIFORNIA NORTH-Yuba City
CALIFORNIA NORTH-San Francisco/Oakland/Hayward (Marin County)
CALIFORNIA NORTH-Vallejo/Fairfield
CALIFORNIA NORTH-Bakersfield
CALIFORNIA NORTH-Chico
CALIFORNIA NORTH-Fresno
CALIFORNIA NORTH-Hanford/Corcoran
CALIFORNIA NORTH-Madera
CALIFORNIA NORTH-Merced
CALIFORNIA NORTH-Modesto
CALIFORNIA NORTH-Redding
CALIFORNIA NORTH-Riverside/San Bernardino/Ontario
CALIFORNIA NORTH-Sacramento/Roseville/Arden/Arcade
CALIFORNIA NORTH-Salinas
CALIFORNIA NORTH-San Jose/Sunnyvale/Santa Clara (San Benito County)
CALIFORNIA NORTH-Santa Cruz/Watsonville
CALIFORNIA NORTH-Santa Rosa
CALIFORNIA NORTH-Stockton/Lodi
CALIFORNIA NORTH-Visalia/Porterville
CALIFORNIA SOUTH-Ventura
CALIFORNIA SOUTH-Los Angeles
CALIFORNIA SOUTH-Anaheim/Santa Ana
CALIFORNIA SOUTH-El Centro
CALIFORNIA SOUTH-San Diego/Carlsbad
CALIFORNIA SOUTH-San Luis Obispo/Paso Robles/Arroyo Grande
CALIFORNIA SOUTH-Santa Maria/Santa Barbara
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
2019 Laboratory Fee Schedule: $11.48


2019A 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.
Percentage
ICD-10 Code
Description
Related DRG(s)
3.8%
I10
Essential (primary) hypertension
304-305
3.0%
E11.9
Type 2 diabetes mellitus without complications
008
010
637-639
2.5%
R53.83
Other fatigue
947-948
2.3%
R94.5
Abnormal results of liver function studies
441-443
2.3%
Z79.899
Other long term (current) drug therapy
949-950
2.3%
R74.0
Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]
947-948
2.2%
B18.2
Chronic viral hepatitis C
441-443
793
2.1%
Z11.3
Encounter for screening for infections with a predominantly sexual mode of transmission
951
2.1%
D64.9
Anemia, unspecified
811-812
2.0%
R79.89
Other specified abnormal findings of blood chemistry
947-948

* Commonly Associated ICD-10 codes derived from CMS Q3 2016 Limited Data Set (LDS) claims data.
This data represents an analysis of 11,119,991 claims processed for 1,414,138 beneficiaries in the third quarter of 2016.

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

87340 not found in an Local Coverage Determination (LCD) for your contractor. Other contractors covering 87340


See also: Medicare Preventative Services


CCI and MUE Edits*         Hide this section.

Multiple Code CCI/MUE Edit Report-New



Column 2 CCI Edits for 87340
Denied Codes (1) Effective Modifier
Accepted (2)
80074 ACUTE HEPATITIS PANEL 06/05/2000 No
80081 OBSTETRIC PANEL 01/01/2016 No
87147 CULTURE TYPE IMMUNOLOGIC 04/01/2002 Yes
87253 VIRUS INOCULATE TISSUE ADDL 04/01/2002 Yes
G0499 Hepb screen high risk indiv 07/01/2017 No
(1) These codes will be denied when submitted for payment on the same date of service as 87340.

(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 87340

Practitioner
Hospital Outpatient
DME Supplier
Allowed Frequency per Day: 1 1 Not Listed
Adjudication Indicator: 2 Date of Service Edit: Policy 2 Date of Service Edit: Policy Not Listed
Rationale: Code Descriptor / CPT Instruction Code Descriptor / CPT Instruction Not Listed

* CCI Source Data: Practitioner P2P Coding Edits. For more information on these edits or to view the Hospital Outpatient Edits, please visit https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

MUE Source Data: For more information on these edits, please visit href='https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html

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.



   87340 Top 5 Ordering Providers National* - Extended NPI Market Analysis Search
LEVON SARDARYAN -BURBANK,CA 1,435
WILLIAM MORICE -ROCHESTER,MN 1,269
JORGE ZAMORA-QUEZADA -EDINBURG,TX 1,006
MICHAEL VALACHOVIC -DALLAS,TX 841
JON KELLER -PALO ALTO,CA 691

   87340 Top 5 Ordering Organizations National*
LABORATORY CORPORATION OF AMERICA HOLDINGS-NC 21,641
BIO-REFERENCE LABORATORIES, INC.-NJ 15,627
LABORATORY CORPORATION OF AMERICA HOLDINGS-NJ 12,191
UNILAB CORPORATION-CA 9,104
QUEST DIAGNOSTICS INCORPORATED-NJ 8,586

*Based on 2016 Medicare Fee-For Service Provider Utilization & Payment Data, Physician and Other Supplier, Public Use File



   Medicare Part B Utilization Data for 87340*         Hide this section.



Annual Performed / Denied


Total National Services (all modifiers) Submitted 2017: 392,210
Total Services Denied 2017: 67,561 (17.2%)
National Charges Submitted 2017: $ 26,286,101.41
National Charges Allowed 2017: $ 4,512,259.94
National Average (No Modifier) Fee Submitted 2017: $ 66.26
National Average (No Modifier) Fee Allowed 2017: $ 13.90
National Average (26) Fee Submitted 2017: $ 23.62
National Average (26) Fee Allowed 2017: $ 0.00


Top 5 Performing Specialties 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Clinical laboratory
(billing independently)
364,058 92.8% $ 68.87 61,330 16.8%
Rheumatology
(eff 5/92)
6,585 1.7% $ 45.85 667 10.1%
Pathology 5,435 1.4% $ 40.28 1,680 30.9%
Internal medicine 3,878 1.0% $ 38.07 874 22.5%
Hematology/oncology
(eff 5/92)
2,984 0.8% $ 41.41 1,151 38.6%

Top 5 Places of Service 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
Independent laboratory 362,357 92.4% $ 68.97 61,007 16.8%
Office 28,370 7.2% $ 43.83 5,765 20.3%
Independent Clinic 524 0.1% $ 23.66 289 55.2%
Nursing facility 451 0.1% $ 34.09 113 25.1%
On Campus-Outpatient Hospital 210 0.1% $ 35.93 196 93.3%

Top 5 Modifiers Submitted 2017 Total Services Percent
of Total
Average
Amount
Submitted
Denials Percent
Denied
No Modifier 351,914 89.7% $ 66.26 55,272 15.7%
90 - Reference (Outside) Laboratory 18,546 4.7% $ 65.26 2,645 14.3%
GA - Advanced Beneficiary Notice (ABN) on File 14,800 3.8% $ 72.20 6,584 44.5%
AY 3,299 0.8% $163.61 503 15.2%
GZ - Service Expected to be Denied as Not Reasonable and Necessary 1,961 0.5% $ 44.45 1,961 100.0%

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.


   CodeMap Compliance Briefings: Hide this section.

CMS Transmittals Referencing "87340"
Issue DateTransmittalTitle
2018-12-13 R254BP Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2019
2018-11-14 R250BP Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment fo
2018-06-15 R4073CP Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
2017-12-15 R3934CP Calendar Year (CY) 2018 Annual Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment
2017-11-03 R237BP Implementation of Changes in the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) and Payment for Dialysis Furnished for Acute Kidney Injury (AKI) in ESRD Facilities for Calendar Year (CY) 2018
2017-08-11 R3833CP Quarterly Update to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS)
2017-08-04 R3831CP Screening for Hepatitis B Virus (HBV) Infection
2017-06-09 R3793CP Screening for Hepatitis B Virus (HBV) Infection


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

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01/23/2019 07:09:46 54.172.221.7

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