tci Part B Insider - 2012 Issue 40

Reader Question: 'Grandfather Provision' Expiration Causes Headaches for Labs

Question: Since the TC Grandfather Provision ended July 1, 2012, we're receiving approximately six denials per week from our Medicare contractor for anatomic pathology services for non-hospital patients. For example, a Medicare patient went to a physician's office and had a skin lesion removed. Our pathology lab received the skin specimen, processed it, and reported back to the physician. We billed 88305, but received a denial indicating "not a covered service -- Must bill to part A contractor."Our MAC representative told us that the patient received another service on the same day as a hospital outpatient (place of...

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