Program_Memos / 2000 / AB-00-109

Why This Topic Matters

The memorandum affects how laboratory services are priced, mapped, and processed for 2001, including several code additions, deletions, and gap-fill items. It also provides operational guidance that supports consistent claims processing across Medicare and related payer settings.

Article Sections

1. Fees and National Limitation Amounts

   Summarizes the fee schedule update framework for the year and describes how national limitation amounts are handled in the 2001 file.

2. Data File Format

   Describes the structure of the laboratory fee schedule data file and the pricing-related fields included in the file layout.

3. Access to Data File and Program Memoranda

   Explains how the fee schedule file and related program memoranda were distributed to contractors and other audiences.

4. Comments

   Provides administrative instructions for submitting comments on future laboratory fee schedule development.

5. Pricing and Billing Information

   Covers coding changes, mapping concepts, and billing-related topics for clinical diagnostic laboratory services in the 2001 schedule.

6. Organ or Disease Oriented Panels

   Addresses how panel pricing was derived and how the related file fields were populated for these services.

7. Cervical or Vaginal Smear Tests (Pap Smears)

   Discusses gap-fill handling and other administrative issues affecting Pap smear-related laboratory services.

8. Glucose Monitoring

   Notes related program memoranda and identifies the general service area covered by the glucose monitoring guidance.

9. HIV Resistance Testing

   Summarizes the addition of more specific HIV resistance testing coding and the broader payment and coverage context surrounding those services.

10. Mapping Information

    Lists the mapping relationships used for newly created or revised laboratory codes in the 2001 schedule.

11. Gap-Fill Codes

    Describes the gap-fill process and timing for codes that require carrier-priced amounts in the 2001 fee schedule.

12. Laboratory Costs Subject to Reasonable Charge Payment Methodology in 2001

    Identifies laboratory-related services and product categories that remain subject to reasonable charge methodology in certain settings.

13. Institute of Medicine Study

    References a Congressionally mandated study examining Medicare payment for outpatient laboratory services and the broader policy context.

14. Attachment A

    Provides the record layout for the 2001 clinical diagnostic laboratory fee schedule data file.

15. Attachment B

    Lists new, deleted, and gap-fill-related laboratory codes included with the memorandum.

16. Attachment C

    Outlines the process for submitting 2001 gap-fill amounts and the associated file specifications.