Medicare_Claims_Processing_Manual / 363

Why This Topic Matters

The update affects how Medicare Part B laboratory services are priced and processed for 2005, so it is relevant to organizations that bill, load, or administer laboratory claims and payment files.

Article Sections

1. General Information

   Background and policy context for the annual laboratory fee schedule update, including the overall scope of the recurring notification.

2. Update to Fees

   General discussion of the annual fee schedule update framework and payment methodology for clinical laboratory services.

3. National Minimum Payment Amounts

   Overview of the minimum payment framework that applies to a subset of laboratory tests under the annual update.

4. National Limitation Amounts (Maximum)

   Summary of how national limitation amounts are established for certain tests under the fee schedule.

5. Access to Data File

   Instructions and availability information for retrieving the annual clinical laboratory fee schedule data file.

6. Data File Format

   Description of the carrier and intermediary record layouts used in the laboratory fee schedule data files.

7. Public Comments

   Information about CMS public input and comment timing related to laboratory fee schedule payment determinations.

8. Pricing Information

   General pricing update information for selected laboratory services and specimen collection-related items.

9. Organ or Disease Oriented Panel Codes

   Discussion of how certain panel and evocative/suppression test prices were derived for the year.

10. Mapping Information for New and Revised Codes

    Overview of how selected new laboratory codes were mapped to existing payment values for the 2005 schedule.

11. Gap-fill Payments for New Laboratory Tests

    General explanation of CMS gap-fill methodology and comment considerations for new laboratory tests.

12. Laboratory Costs Subject to Reasonable Charge Payment in 2005

    Coverage of laboratory services paid under reasonable charge rules and the related administrative references.

13. Blood Products

    List of blood product-related laboratory service codes addressed under the reasonable charge discussion.

14. Transfusion Medicine

    Transfusion medicine laboratory codes identified in the annual update.

15. Reproductive Medicine Procedures

    Reproductive medicine procedure codes identified in the annual update.

16. Provider Education

    Provider education and contractor communication instructions related to the transmittal.

17. Business Requirements

    Administrative business requirement reference for the transmittal implementation.

18. Supporting Information and Possible Design Considerations

    Implementation notes, cross references, and system-related considerations supporting the update.

19. Schedule, Contacts, and Funding

    Effective dates, implementation timing, and CMS contact information for the update.

20. Attachment A: Carrier Record Layout for Data File

    Carrier file layout details for the 2005 clinical laboratory fee schedule data set.

21. Attachment B: Intermediary Record Layout for Data File

    Intermediary file layout details for the 2005 clinical laboratory fee schedule data set.

22. Attachment C: 2005 Clinical Laboratory Fee Schedule

    Summary list of new codes and the status of deleted or gap-filled codes for the 2005 schedule.