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On October 31, 2014 CMS submitted its Final Rule for the Medicare Professional Fee Schedule.  This information has been much anticipated due to addition of new CPT codes related to ISH and IHC.  Along with the addition of these codes, we have seen some changes in RVU values that have driven down reimbursement, most notably for ISH coding.  Also noteworthy is a 15% increase to 88342-26 (previously G0461 for CMS) and a decrease to the 88342-TC of 6%.  The below PDF contains a chart that summarizes these values.

The AMA’s Current Procedural Terminology (CPT) 2015 has been published and brings many changes to radiology.  Each year the CPT manual is updated to add, delete, or revise codes, and/or to modify guidelines where needed to reflect current technologies, techniques, and provision of services.  Illustrated below are some of the main changes that will impact coding and billing for diagnostic radiology services, effective January 1, 2015. 

In 2015, Pathology will see many CPT changes.  Some of the bigger changes will include changes to immunohistochemistry codes (88342, 88360 and 88361) as well as the ISH series of codes (88365, 88367 and 88368).  As we have seen in previous years there will be revisions, deletions and additions to these code sets

Modifier 59 (Distinct Procedural Service) is described by the Centers for Medicare and Medicaid Services (CMS) as the most widely used HCPCS modifier.  In its August 15, 2014 Transmittal R1422, CMS contends that there are three common reasons that modifier 59 is used:

• Identify a separate session or encounter
• Define a separate anatomic site
• Indicate a distinct service

The Centers for Medicare and Medicaid Services (CMS) is enforcing Medically Unlikely Edits (MUEs) by expanding screening edits that will deny claims for bilateral billing.


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