Medicare Claims Processing Manual (Pub. 100-04), Ch. 16 § 100.2

Laboratory Tests Never Subject to the Fee Schedule

Last amended: 2003Year: 2003Length: 133 wordsOfficial source
100.2 - Laboratory Tests Never Subject to the Fee Schedule (Rev. 1, 10-01-03) Some CPT codes in the 80000 series are not clinical laboratory tests and are therefore never subject to fee schedule limitations. Some of these codes are exempted because they are not clinical laboratory services. They include codes for procedures, services, blood products and auto-transfusions. They include codes such as whole blood, various red blood cell products, platelets, plasma, and cryoprecipitate. Other codes for tests primarily associated with the provision of blood products are also not considered to be clinical tests. Such tests identify various characteristics of blood products, but are not diagnostic in nature. These include various blood cross matching techniques. If they are covered, Medicare pays exclusion codes under the MPFS, reasonable charges, reasonable costs, or OPPS as applicable.
Medicare Claims Processing Manual (Pub. 100-04), Ch. 16 § 100.2: Laboratory Tests Never Subject to the Fee Schedule | Justis AI