Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid www.mass.gov/masshealth MassHealth Transmittal Letter LAB-40 May 2012 TO: Independent Clinical Laboratories Participating in MassHealth FROM: Julian J. Harris, M.D., Medicaid Director RE: Independent Clinical Laboratory Manual (Update to 2012 HCPCS) This letter transmits revisions to the service codes for BRCA testing in the Independent Clinical Laboratory Manual. The Centers for Medicare & Medicaid Services (CMS) has revised the Healthcare Common Procedure Coding System (HCPCS) codes for April 1, 2012. The revised Subchapter 6 is effective for dates of service on or after April 1, 2012. These revisions are listed below. Deleted Code/Modifier Replacement Code/Modifier S3820 81211 S3820/QP 81211/59 S3822 81215 S3823 81212 Division of Health Care Finance and Policy (DHCFP) regulations establish the fee schedule for covered services in the Independent Clinical Laboratory Manual. You may download the regulations at no cost at www.mass.gov/dhcfp, or purchase a paper copy from either the Massachusetts State Bookstore or from the Division of Health Care Finance and Policy (see addresses and telephone numbers below). You must contact them first to find out the price of the paper copy of the publication. The specific regulation titles for laboratory services are Surgery and Anesthesia Services: 114.0.3 CMR 16.00 and Clinical Laboratory Services: 114.3 CMR 20.00. Massachusetts State Bookstore State House, Room 116 Boston, MA 02133 Telephone: 617-727-2834 www.mass.gov/sec/spr Division of Health Care Finance and Policy Two Boylston Street Boston, MA 02116 Telephone: 617-988-3100 www.mass.gov/dhcfp MassHealth Web Site This transmittal letter and attached pages are available on the MassHealth Web site at www.mass.gov/masshealth. MassHealth Transmittal Letter LAB-40 May 2012 Page 2 Questions If you have any questions about this transmittal letter, please contact MassHealth Customer Service at 1-800-841-2900, e-mail your inquiry to providersupport@mahealth.net, or fax your inquiry to 617-988-8974. NEW MATERIAL (The pages listed here contain new or revised language.) Independent Clinical Laboratory Manual Pages vi and 6-1 through 6-6 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Independent Clinical Laboratory Manual Pages vi and 6-1 through 6-6 — transmitted by Transmittal Letter LAB-39 Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title Table of Contents Page vi Independent Clinical Laboratory Manual Transmittal Letter LAB-40 Date 04/01/12 6. Service Codes Introduction.............................................................6-1 Payable Laboratory Services..............................................6-1 Modifiers................................................................6-6 Appendix A. Directory........................................................A-1 Appendix B. Enrollment Centers...............................................B-1 Appendix C. Third-Party-Liability Codes......................................C-1 Appendix W. EPSDT Services: Medical and Dental Protocols and Periodicity Schedules........................................W-1 Appendix X. Family Assistance Copayments and Deductibles.....................X-1 Appendix Y. EVS Codes/Messages...............................................Y-1 Appendix Z. EPSDT/PPHSD Screening Services Codes.............................Z-1 Commonwealth of Massachusetts MassHealth Provider Manual Series Independent Clinical Laboratory Manual Subchapter Number and Title 6. Service Codes Page 6-1 Transmittal Letter LAB-40 Date 04/01/12 601 Introduction MassHealth providers should refer to the American Medical Association’s Current Procedural Terminology (CPT) code book or the Healthcare Common Procedure Coding System (HCPCS) Level II code book for the service codes and service descriptions when billing for services provided to MassHealth members. MassHealth pays for the services represented by the codes listed in Subchapter 6 in effect at the time of service, subject to all conditions and limitations in MassHealth regulations at 130 CMR 401.000 and 450.000. An independent clinical laboratory may request prior authorization for any medically necessary service reimbursable under the federal Medicaid Act in accordance with 130 CMR 450.144, 42 U.S.C. 1396d(a), and 42 U.S.C. 1396d(r)(5) for a MassHealth Standard or CommonHealth member younger than 21 years of age, even if it is not designated as covered or payable in Subchapter 6 of the Independent Clinical Laboratory Manual. The following abbreviations are used in Subchapter 6. (A) IC: Claim requires individual consideration. See 130 CMR 401.419 and 450.271 for more information. (B) PA: Service requires prior authorization. See 130 CMR 450.303 for more information. 602 Payable Laboratory Services This section lists CPT codes and HCPCS Level II codes that are payable under MassHealth. 80047 80048 80050 80051 80053 80055 80061 80069 80074 80076 80102 80103 80150 80152 80154 80156 80157 80158 80160 80162 80164 80166 80168 80170 80172 80173 80174 80176 80178 80182 80184 80185 80186 80188 80190 80192 80194 80195 80196 80197 80198 80200 80201 80202 80299 80400 80402 80406 80408 80410 80412 80414 80415 80416 80417 80418 80420 80422 80424 80426 80428 80430 80432 80434 80435 80436 80438 80439 80440 81000 81001 81002 81003 81005 81007 81015 81020 81025 81050 81099 (IC) 81211 81211-59 81212 81215 82000 82003 82009 82010 82013 82016 82017 82024 82030 82040 82042 82043 82044 82045 82055 82085 82088 82101 82103 82104 82105 82106 82107 82108 82120 82127 82128 82131 82135 82136 82139 82140 82143 82145 82150 82154 82157 82160 82163 82164 82172 82175 82180 82190 82205 82232 82239 82240 82247 82248 82252 Commonwealth of Massachusetts MassHealth Provider Manual Series Independent Clinical Laboratory Manual Subchapter Number and Title 6. Service Codes Page 6-2 Transmittal Letter LAB-40 Date 04/01/12 82261 82270 82271 82272 82274 82286 82300 82306 82308 82310 82330 82331 82340 82355 82360 82365 82370 82373 82374 82375 82376 82378 82379 82380 82382 82383 82384 82387 82390 82397 82415 82435 82436 82438 82441 82465 82480 82482 82485 82486 82487 82488 82489 82491 82492 82495 82507 82520 82523 82525 82528 82530 82533 82540 82541 82542 82543 82544 82550 82552 82553 82554 82565 82570 82575 82585 82595 82600 82607 82608 82610 82615 82626 82627 82633 82634 82638 82646 82649 82651 82652 82654 82656 82657 82658 82664 82666 82668 82670 82671 82672 82677 82679 82690 82693 82696 82705 82710 82715 82725 82726 82728 82731 82735 82742 82746 82747 82757 82759 82760 82775 82776 82784 82785 82787 82800 82803 82805 82810 82820 82930 82938 82941 82943 82945 82946 82947 82948 82950 82951 82952 82953 82955 82960 82963 82965 82975 82977 82978 82979 82980 82985 83001 83002 83003 83008 83009 83010 83012 83013 83014 83015 83018 83020 83021 83026 83030 83033 83036 83037 83045 83050 83051 83055 83060 83065 83068 83069 83070 83071 83080 83088 83090 83150 83491 83497 83498 83499 83500 83505 83516 83518 83519 83520 83525 83527 83528 83540 83550 83570 83582 83586 83593 83605 83615 83625 83630 83631 83632 83633 83634 83655 83661 83662 83663 83664 83670 83690 83695 83698 83700 83701 83704 83718 83719 83721 83727 83735 83775 83785 83788 83789 83805 83825 83835 83840 83857 83858 83861 83864 83866 83872 83873 83874 83876 Commonwealth of Massachusetts MassHealth Provider Manual Series Independent Clinical Laboratory Manual Subchapter Number and Title 6. Service Codes Page 6-3 Transmittal Letter LAB-40 Date 04/01/12 83880 83883 83885 83887 83890 83891 83892 83893 83894 83896 83897 83898 83900 83901 83902 83903 83904 83905 83906 83907 83908 83909 83912 83913 83914 83915 83916 83918 83919 83921 83925 83930 83935 83937 83945 83950 83951 83970 83986 83992 83993 84022 84030 84035 84060 84066 84075 84078 84080 84081 84085 84087 84100 84105 84106 84110 84112 84119 84120 84126 84127 84132 84133 84134 84135 84138 84140 84143 84144 84146 84150 84152 84153 84154 84155 84156 84157 84160 84163 84165 84166 84181 84182 84202 84203 84206 84207 84210 84220 84228 84233 84234 84235 84238 84244 84252 84255 84260 84270 84275 84285 84295 84300 84302 84305 84307 84311 84315 84375 84376 84377 84378 84379 84392 84402 84403 84425 84430 84432 84436 84437 84439 84442 84443 84445 84446 84449 84450 84460 84466 84478 84479 84480 84481 84482 84484 84485 84488 84490 84510 84512 84520 84525 84540 84545 84550 84560 84577 84578 84580 84583 84585 84586 84588 84590 84591 84597 84600 84620 84630 84681 84702 84703 84704 84999 (IC) 85002 85004 85007 85008 85009 85013 85014 85018 85025 85027 85032 85041 85044 85045 85046 85048 85049 85055 85060 85097 85130 85170 85175 85210 85220 85230 85240 85244 85245 85246 85247 85250 85260 85270 85280 85290 85291 85292 85293 85300 85301 85302 85303 85305 85306 85307 85335 85337 85345 85347 85348 85360 85362 85366 85370 85378 85379 85380 85384 85385 85390 85396 85397 85400 85410 85415 85420 85421 85441 85445 Commonwealth of Massachusetts MassHealth Provider Manual Series Independent Clinical Laboratory Manual Subchapter Number and Title 6. Service Codes Page 6-4 Transmittal Letter LAB-40 Date 04/01/12 85460 85461 85475 85520 85525 85530 85536 85540 85547 85549 85555 85557 85576 85597 85598 85610 85611 85612 85613 85635 85651 85652 85660 85670 85675 85705 85730 85732 85810 85999 (IC) 86000 86001 86003 86005 86021 86022 86023 86038 86039 86060 86063 86140 86141 86146 86147 86148 86155 86156 86157 86160 86161 86162 86171 86185 86200 86215 86225 86226 86235 86243 86255 86256 86277 86280 86294 86300 86301 86304 86308 86309 86310 86316 86317 86318 86320 86325 86327 86329 86331 86332 86334 86335 86336 86337 86340 86341 86343 86344 86352 86353 86355 86356 86357 86359 86360 86361 86367 86376 86378 86382 86384 86386 86403 86406 86430 86431 86480 86481 86485 86486 86490 86510 86590 86592 86593 86602 86603 86606 86609 86611 86612 86615 86617 86618 86619 86622 86625 86628 86631 86632 86635 86638 86641 86644 86645 86648 86651 86652 86653 86654 86658 86663 86664 86665 86666 86668 86671 86674 86677 86682 86684 86687 86688 86689 86692 86694 86695 86696 86698 86701 86702 86703 86704 86705 86706 86707 86708 86709 86710 86713 86717 86720 86723 86727 86729 86732 86735 86738 86741 86744 86747 86750 86753 86756 86757 86759 86762 86765 86768 86771 86774 86777 86778 86780 86784 86787 86788 86789 86790 86793 86800 86803 86804 86805 86806 86807 86808 86812 86813 86816 86817 86821 86822 86825 86826 86849 (IC) 86850 86860 86870 86880 86885 86886 86900 86901 86902 86904 86905 86906 86920 86921 86922 86923 86940 86941 86970 Commonwealth of Massachusetts MassHealth Provider Manual Series Independent Clinical Laboratory Manual Subchapter Number and Title 6. Service Codes Page 6-5 Transmittal Letter LAB-40 Date 04/01/12 86971 86972 86975 86976 86977 86978 86999 (IC) 87001 87003 87015 87040 87045 87046 87070 87071 87073 87075 87076 87077 87081 87084 87086 87088 87101 87102 87103 87106 87107 87109 87110 87116 87118 87140 87143 87147 87149 87152 87158 87164 87166 87168 87169 87172 87176 87177 87181 87184 87185 87186 87187 87188 87190 87197 87205 87206 87207 87209 87210 87220 87230 87250 87252 87253 87254 87255 87260 87265 87267 87269 87270 87271 87272 87273 87274 87275 87276 87277 87278 87279 87280 87281 87283 87285 87290 87299 87300 87301 87305 87320 87324 87327 87328 87329 87332 87335 87336 87337 87338 87339 87340 87341 87350 87380 87385 87389 87390 87391 87400 87420 87425 87427 87430 87449 87450 87451 87470 87471 87472 87475 87476 87477 87480 87481 87482 87485 87486 87487 87490 87491 87492 87495 87496 87497 87498 87500 87501 87502 87503 87510 87511 87512 87515 87516 87517 87520 87521 87522 87525 87526 87527 87528 87529 87530 87531 87532 87533 87534 87535 87536 87537 87538 87539 87540 87541 87542 87550 87551 87552 87555 87556 87557 87560 87561 87562 87580 87581 87582 87590 87591 87592 87620 87621 87622 87640 87641 87650 87651 87652 87653 87660 87797 87798 87799 87800 87801 87802 87803 87804 87807 87808 87809 87810 87850 87880 87899 87900 87901 87902 87903 87904 87905 87906 87999 (PA)(IC) 88104 88106 88108 88112 88120 88121 88130 88140 88141 88142 88143 88147 88148 88150 88152 88153 88154 88155 88160 88161 88162 88164 Commonwealth of Massachusetts MassHealth Provider Manual Series Independent Clinical Laboratory Manual Subchapter Number and Title 6. Service Codes Page 6-6 Transmittal Letter LAB-40 Date 04/01/12 88165 88166 88167 88172 88173 88174 88175 88177 88182 88184 88185 88187 88188 88189 88199 (IC) 88230 88233 88235 88237 88239 88240 88241 88245 88248 88249 88261 88262 88263 88264 88267 88269 88271 88272 88273 88274 88275 88280 88283 88285 88289 88291 88299 (IC) 88300 88302 88304 88305 88307 88309 88311 88312 88313 88314 88319 88342 88346 88347 88348 88349 88355 88356 88358 88360 88361 88362 88363 88365 88367 88368 88371 88372 88380 (IC) 88381 88384 88385 88386 88387 88388 88399 (IC) 88720 88740 88741 89049 89050 89051 89055 89060 89125 89160 89190 89220 (IC) 89230 (IC) 89240 (IC) 93000 93005 93010 93015 93016 93017 93018 93024 93040 93041 93042 93224 93225 93226 93227 93228 93229 (IC) 93268 93278 93724 93799 (IC) G0431 G0434 P9604 603 Modifiers The following service code modifiers are allowed for billing under MassHealth. Modifier Description 91 Repeat clinical diagnostic laboratory test 59 Can be used only with service code 81211