Every year, there are new CPT codes introduced into the laboratory and pathology industries. As changes occur, it is imperative that your group understands that these new CPT codes may not automatically be added and paid at the correct contracted rate by your carriers. Many carriers will not automatically add new CPT codes to the contract and, instead, will deny the charge as non-covered, experimental, etc. Some carriers will add the new CPT codes to the contract; however, they may pay at a very low reimbursement rate. For example, APS is currently fighting carriers (for both new and existing clients) to ensure that the new IHC stain codes are not only added, but that higher reimbursement rates are being used for these codes.
Many state Medicaid programs are very slow to add new CPT codes to their fee schedules. California MediCal and Pennsylvania Medicaid are prime examples of state Medicaid programs that take a very long time to get their fee schedules updated. For carriers such as these, it is important that your accounts are being worked timely with diligent follow up to ensure that these carriers are adding all approved codes to their published fee schedules. Two particular areas of concern are ensuring that the 2015 IHC stain codes are being reimbursed properly and that the 2016 new immunofluorescent CPT code changes have been properly executed.
APS is committed to ensuring that every new CPT code is being reimbursed at the correct contracted rate for all of our client’s contracts. APS’ Contract Management Department and Practice Managers continue to monitor our client’s contracted fee schedules to make sure that every charge is being reimbursed at the correct rate. If you have any questions at all, please contact your APS Practice Manager.
Brawley, CA