On January 2, 2020, after a few delays, CMS’ Date of Service Exception Policy finally went into effect, overriding the so-called “14 Day Rule” that prevented performing laboratories from billing Medicare directly for molecular pathology and advanced diagnostic lab tests ordered less than 14 days following an outpatient’s discharge from the hospital. In this scenario, labs had to seek their share of the reimbursement from the payment that had been made to the hospital.
The Date of Service Exception (DOS) policy essentially unbundles payment for the performance of these tests from the hospital’s payment and requires that, for the listed CPT codes, the DOS reported for the test be the date the test was performed, not the date the specimen was obtained. This means the performing lab will now bill – and receive payment from - Medicare directly within the following conditions:
• The test was performed following a hospital outpatient’s discharge from the hospital outpatient department;
• The specimen was collected from a hospital outpatient during an encounter;
• It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter;
• The results of the test do not guide treatment provided during the hospital outpatient encounter; and
• The test was reasonable and medically necessary for the treatment of an illness.
The most recent list of designated CPT codes subject to the laboratory DOS exception can be found in the below PDF file. Additional information and FAQs can be accessed at: