Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid 600 Washington Street Boston, MA 02111 www.mass.gov/masshealth MASSHEALTH TRANSMITTAL LETTER LAB-27 July 2006 TO: Independent Clinical Laboratories Participating in MassHealth FROM: Beth Waldman, Medicaid Director RE: Independent Clinical Laboratory Manual (Code Correction) This letter transmits revisions to the service codes and descriptions listed in Subchapter 6 of the Independent Clinical Laboratory Manual. A correction has been made to Service Code 88167, currently listed incorrectly as 86167 on page 6-30. This revision is effective for dates of service on or after January 1, 2006. This transmittal letter, including the attached pages, and other publications issued by MassHealth are available on the MassHealth Web site at www.mass.gov/masshealth. Click on MassHealth Regulations and Other Publications, then on Provider Library. If you have any questions about the information in 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 Independent Clinical Laboratory Manual Pages 6-29 and 6-30 OBSOLETE MATERIAL (The pages listed here are no longer in effect.) Independent Clinical Laboratory Manual Pages 6-29 and 6-30 – transmitted by Transmittal Letter LAB-26 Commonwealth of Massachusetts MassHealth Provider Manual Series Independent Clinical Laboratory Manual Subchapter Number and Title 6 Service Codes and Descriptions Page 6-29 Transmittal Letter Lab-27 Date 01/01/06 601 Laboratory Service Codes and Descriptions (cont.) Service Code Service Description 87651 Streptococcus, group A, amplified probe technique 87652 Streptococcus, group A, quantification 87660 Trichomonas vaginalis, direct probe technique 87797 Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; direct probe technique, each organism 87798 amplified probe technique, each organism 87799 quantification, each organism 87800 Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique 87801 amplified probe(s) technique 87802 Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group B 87803 Clostridium difficile toxin A 87804 influenza 87807 infectious agent antigen detection by immunoassay with direct optical observation, respiratory syncytial virus 87810 Infectious agent detection by immunoassay with direct optical observation; Chlamydia trachomatis 87850 Neisseria gonorrhoeae 87880 Streptococcus, group A 87899 not otherwise specified 87900 Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics 87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV 1, reverse transcriptase and protease 87902 Hepatitis C virus 87903 Infectious agent phenotype analysis by nucleic acid (DNA or RNA) with drug resistance tissue culture analysis, HIV 1; first through 10 drugs tested 87904 each additional drug tested (List separately in addition to code for primary procedure.) (Use 87904 in conjunction with 87903.) 87999 Unlisted microbiology procedure (I.C.) (P.A.) ANATOMIC PATHOLOGY Cytopathology 88104 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation 88106 filter method only with interpretation 88107 smears and filter preparation with interpretation 88108 Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique) 88112 Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal 88130 Sex chromatin identification; Barr bodies 88140 peripheral blood smear, polymorphonuclear drumsticks Commonwealth of Massachusetts MassHealth Provider Manual Series Subchapter Number and Title 6 Service Codes and Descriptions Page 6-30 Independent Clinical Laboratory Manual Transmittal Letter Lab-27 Date 01/01/06 601 Laboratory Service Codes and Descriptions (cont.) Service Code Service Description Codes 88141-88155, 88164-88167 are used to report cervical or vaginal screening by various methods and to report physician interpretation services. Use codes 88150-88154 to report Pap smears that are examined using non-Bethesda reporting. Use codes 88164-88167 to report Pap smears that are examined using the Bethesda System of reporting. Use codes 88142-88143 to report specimens collected in fluid medium with automated thin layer preparation that are examined using any system of reporting (Bethesda or non-Bethesda). Within each of these three code families choose the one code that describes the screening method(s) used. Codes 88141 and 88155 should be reported in addition to the screening code chosen when the additional services are provided. 88141 Cytopathology, cervical or vaginal (any reporting system); requiring interpretation by physician (List separately in addition to code for technical service.) 88142 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143 with manual screening and rescreening under physician supervision 88147 Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision 88148 screening by automated system with manual rescreening under physician supervision 88150 Cytopathology, slides, cervical or vaginal; manual screening under physician supervision 88152 with manual screening and computer-assisted rescreening under physician supervision 88153 with manual screening and rescreening under physician supervision 88154 with manual screening and computer-assisted rescreening using cell selection and review under physician supervision 88155 Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (e.g., maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code(s) for other technical and interpretation services.) 88160 Cytopathology, smears, any other source; screening and interpretation 88161 preparation, screening, and interpretation 88162 extended study involving over five slides and/or multiple stains 88164 Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision 88165 with manual screening and rescreening under physician supervision 88166 with manual screening and computer-assisted rescreening under physician supervision 88167 with manual screening and computer-assisted rescreening using cell selection and review under physician supervision 88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s) 88173 interpretation and report 88174 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by automated system, under physician supervision 88175 with screening by automated system and manual rescreening or review, under physician supervision 88182 Flow cytometry; cell cycle or DNA analysis