Medicare_Claims_Processing_Manual / 4144

Why This Topic Matters

It affects how Medicare Part B laboratory services are priced and processed for 2006, including routine fee schedule updates and special handling for certain laboratory and blood product services. The article also informs contractors about file retrieval, effective dates, and operational instructions tied to the annual update.

Article Sections

1. General Information

   Background and policy context for the annual clinical laboratory fee schedule update. Includes overview topics for payment updates, data file access, and related administrative guidance.

2. Pricing Information

   Information on mapping and pricing for laboratory services, including file-based updates and special payment considerations. Also covers broader categories of laboratory test pricing discussed in the update.

3. Organ or Disease Oriented Panel Codes

   General discussion of pricing methodology used for certain laboratory panel and related test codes. The section describes how the update handles grouped laboratory services.

4. Gap-fill Payments for New Laboratory Tests

   Guidance on the annual gap-fill process for new laboratory tests and the operational timeline for contractors. Covers the general framework for gathering and reporting payment information.

5. Laboratory Costs Subject to Reasonable Charge Payment in 2006

   Overview of laboratory services paid under a reasonable charge methodology for 2006. Includes references to outpatient, dialysis, and blood product related payment handling.

6. Blood Products

   List-based material related to blood product billing and deductible-related handling. The section is tied to Medicare Part B processing for blood products.

7. Transfusion Medicine

   Listing of transfusion medicine laboratory codes included in the update. Provides scope for services in this laboratory specialty area.

8. Reproductive Medicine Procedures

   Listing of reproductive medicine procedure codes included in the update. Indicates the laboratory and procedure categories affected by the annual update.

9. Business Requirements

   Administrative implementation requirements for contractors. The source notes that the detailed chart is unavailable in the provided text.

10. Provider Education

    Provider education material associated with the update. The source notes that the detailed chart is unavailable in the provided text.

11. Supporting Information and Possible Design Considerations

    Supplemental implementation and systems-related information for contractors. Includes references to attachments, instructions, and design-related categories.

12. Schedule, Contacts, and Funding

    Effective dates, implementation dates, contacts, and funding notes for the transmittal. Summarizes administrative timing and outreach information.

13. Attachment A: Carrier Record Layout for Data File

    Carrier data file record layout for the clinical laboratory fee schedule. The chart is not available in the supplied text.

14. Attachment B: Intermediary Record Layout for Data File

    Intermediary data file record layout for the clinical laboratory fee schedule. The chart is not available in the supplied text.

15. Attachment C: Clinical Laboratory Fee Schedule

    Lists the new and deleted laboratory codes for 2006 and identifies codes requiring gap-fill amounts. Also includes supporting notes tied to the annual update.

16. Attachment D: Submitting 2006 Gap-Fill Amounts

    Instructions for submitting gap-fill amount information to regional offices and CMS contacts. The detailed file specification chart is not available in the supplied text.