decisionhealth Newsletters, Answer Books - 2006 Issue 3 (March)
Program_Memos / 2001 / AB-01-42
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Article Overview
This program memorandum explains updates to the 2001 clinical laboratory fee schedule, including fee schedule revisions tied to federal legislation, national minimum payment and limitation concepts, and operational instructions for carriers and intermediaries. It also covers affected HCPCS/CPT laboratory codes, gap-fill processing, data file formats, and timing for distribution and implementation. The article is intended for Medicare billing and coding staff, laboratory billing teams, and payer operations personnel working with 2001 clinical diagnostic laboratory pricing.
Why This Topic Matters
It identifies which laboratory service codes were added, deleted, or require gap-fill handling and describes how the revised fee schedule data were distributed and implemented. That information affects claims processing, fee lookup, and payer administration for the 2001 laboratory schedule.
Article Sections
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Purpose and legislative background
Introduces the memorandum, its change request, and the federal legislative context for the fee schedule update.
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Update to Fees
Summarizes the fee schedule update framework and the timing of the revised payment amounts.
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National Minimum Payment Amounts
Discusses the minimum payment policy applied to certain laboratory tests and identifies the affected code group.
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National Limitation Amounts (Maximum)
Explains the general limitation framework for 2001 and the treatment of codes without a previously established limitation amount.
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Gap-fill Codes
Describes which codes require carrier-determined gap-fill fees and the associated administrative deadlines.
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Data File Format
Outlines the structure of the reissued laboratory fee schedule data file and the fields used for pricing and modifier-related processing.
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Access to Data File and Program Memoranda
Provides information about file distribution, access methods, and related program memorandum retrieval.
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Laboratory Costs Subject to Reasonable Charge Payment Methodology in 2001
Notes that prior guidance remains unchanged for laboratory costs priced under reasonable charge methodology.
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ATTACHMENT A
Contains the record layout for the 2001 clinical diagnostic laboratory fee schedule data file.
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ATTACHMENT B
Lists new, deleted, and gap-fill laboratory codes associated with the 2001 update.
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ATTACHMENT C
Gives the process and file specifications for submitting 2001 gap-fill fee information.
What You Will Learn
- The scope of the 2001 clinical laboratory fee schedule update
- Which categories of laboratory codes were affected
- How gap-fill fees were handled administratively
- How the revised fee schedule data file was structured and distributed
- Which organizations were directed to use the revised schedule and related files
Who Should Read This
- Medicare carriers
- Medicare intermediaries
- Laboratory billing and coding staff
- Clinical laboratory administrators
- Payer operations teams
- Medicaid State Agencies
Codes Discussed
Modifiers Discussed
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