Payment for the Fecal Leukocyte Examination Under a Clinical Laboratory Improvement Amendments of 19 RETIRED
Medicare Coverage Articles
Medicare Policies and Guildelines
The Clinical Laboratory Improvement Amendments of 1988 (CLIA) require a facility to be appropriately certified for each test performed. A facility that has a CLIA certificate for provider-performed microscopy (PPM) procedures may only perform tests that are categorized as either PPM procedures or waived tests under CLIA.
The healthcare common procedure coding system (HCPCS) code G0026 (fecal leukocyte examination) was discontinued on December 31, 2002. For calendar year (CY) 2003, HCPCS code 89055 (Leukocyte count, fecal) was suggested as a possible code to be used for the discontinued G0026. However, under CLIA, the fecal leukocyte examination permitted for a PPM procedure certificate does not include a fecal leukocyte count. For CY 2003, Medicare permitted the use of existing HCPCS code Q0111 (Wet mounts, including preparations of vaginal, cervical or skin specimens) for fecal leukocyte examination claims submitted by facilities with a valid PPM procedure CLIA certificate with dates of services on or after January 1, 2003.
The wording of the HCPCS code 89055 was revised for CY 2004 to read "Leukocyte assessment, fecal, qualitative or semiquantitative." The revised text meets the CLIA definition of the PPM procedure for the fecal leukocyte examination. Beginning January 1, 2004, a facility with a valid CLIA certificate for PPM procedures shall submit claims for the fecal leukocyte examination using the healthcare common procedure coding system(HCPCS) code 89055.