CMS clarifies rules for U0005 COVID add-on payment
When CMS announced its intent to reduce payments for high-throughput COVID-19 tests next year while offering providers a path to be made whole if they met new turnaround time targets, several questions arose concerning how the agency intended to monitor its new...
MolDX removes coverage for BioFire, GenMark respiratory panels
As of Oct. 1, MOLDX has updated their LCDs/Billing and Coding Articles for the Multiplex Nucleic Amplified Tests for Respiratory Panels to no longer cover the PLA codes 0098-0099U, U100U, and 0115U. These PLA codes represent respiratory panels using BioFire® or...
LCD causing issues surrounding reimbursement for respiratory viral panels during PHE
LCD Alert: Multiplex Nucleic Acid Amplified Tests for Respiratory Viral Panels During the COVID-19 PHE (Noridian and Palmetto) Issue: Covered under limited circumstances Introduction and Disclosure: Lighthouse RCM Solutions is a revenue enhancement and laboratory...
UHC issuing recoupments on 88305 prostate biopsies for Medicare Advantage members
We’ve recently seen many commercial payers move to only paying prostate biopsies coded G0416 instead of 88305 (for instance, Cigna will institute this rule effective Aug. 18). It’s not exactly a major surprise to see them adopting CMS guidelines on this...