Michigan Medicaid - Trials & Tribulations of the 2014 & 2015 IHC CPT Codes

In 2015, CPT codes G0461 and G0462 were discontinued and replaced by CPT codes 88341 and 88342 by the Centers for Medicare and Medicaid (CMS), along with 88344 for coding “cocktail” stains.  Previously in year 2014, Michigan Medicaid, reimbursed both the G0461 and G0462 for pathologists.  Beginning with the updated CMS fee schedule for January 2015, the G0461 and G0462 CPT codes were deleted (removed as payable); however the newly determined CPT codes 88341, 88342, and 88344 were not added to the fee schedule (added as payable).   It seems that not only did Michigan Medicaid not add the IHC codes for 2015, but they deleted the “G” codes.

APS posed the question to Michigan Medicaid, “What CPT codes for 2015 dates of service should providers use to bill IHC stains?”  APS was recently informed of the following decision:

Michigan Department of Community Health, Medical Services Administration – Program Policy Division, stated that they (MDCH’s Reference and Benefit Plan Section) worked to review and implement APS’ request (question).  As a result, CPT procedure codes 88341, 88342, 88344 will be activated for individual practitioners for dates of service on or after 1/1/2015.  CPT procedure code 88343 was discontinued by CMS on 12/31/14 and cannot be reactivated.

It is anticipated that the requisite changes will be made in the CHAMPS system within the next 7 to 10 work days (late March 2015).  You may submit or adjust any affected claims after that time period.

As you can see, although APS diligently worked Michigan Medicaid denials respective to the use of the new 2015 CPT codes for IHC, and subsequently pursued the appropriate resolution; this will essentially impact the first full quarter of this year’s Medicaid business (specific to CPT codes 88341, 88342, and 88344).  Although this is not lost revenue, there will be a delay in recovering the revenue.  APS will begin refiling the erroneously denied claims and look to recover payment in the normal due processing time, once the CPTs are added to MI Medicaid’s fee schedule and are deemed payable.