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Changes to the Reimbursement for Physician Pathology, Medicine and Surgical Services with a Professional (26) and Technical (TC) Component

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Changes to the Reimbursement for Physician Pathology, Medicine and Surgical Services with a Professional (26) and Technical (TC) Component Connecticut Medical Assistance Program Provider Bulletin 2015-62 Policy Transmittal 2015-28 August 2015 Effective Date: September 7, 2015 Roderick L. Bremby, Commissioner Contact: Nina Holmes @ 860-424-5486 TO: Physicians, Physician Assistants, Advanced Practice Registered Nurses, Certified Nurse Midwives, Optometrists, and Podiatrists RE: Changes to the Reimbursement for Physician Pathology, Medicine and Surgical Services with a Professional (26) and Technical (TC) Component This policy transmittal is being sent to notify providers Accessing the Fee Schedules that, effective for dates of service September 7, 2015 Fee schedules can be accessed and downloaded by and forward, the Department of Social Services is going to the Connecticut Medical Assistance Web site: revising the reimbursement for the professional and www.ctdssmap.com. From this Web page, go to technical components of select pathology, medicine “Provider”, then to “Provider Fee Schedule and surgical services to 57.5% of the 2007 Medicare Download”, click on the “I accept” button and then Physician Fee Schedule. The Department is proceed to the “Physician Office and Outpatient Fee implementing this change in order to establish a pricing Schedule” or “Physician Surgical Fee Schedule”. To methodology consistent with Medicare, where, for a access the CSV file, press the control key while given service that includes a professional and technical clicking the CSV link, then select “Open”. component, the fee for the professional component, added together with the fee for the technical For questions about billing or if further assistance is component, equals the global fee. needed to access the fee schedule on the Connecticut Medical Assistance Program Web site, please contact The services impacted include select pathology the HP Provider Assistance Center, Monday through services billed under the LAB rate type off of the Friday from 8:00 a.m. to 5:00 p.m. at 1-800-842-8440. Physician Office and Outpatient Fee Schedule, select gastroenterology, ophthalmology, otorhinolaryngology, Posting Instructions: Policy transmittals can be cardiovascular, noninvasive vascular diagnostic downloaded from the Connecticut Medical Assistance studies, pulmonary and neurology & neuromuscular Program Web site at www.ctdssmap.com. procedures and select surgical services that have been identified as including a professional and technical Distribution: This policy transmittal is being component on the Medicare Physician Fee Schedule. distributed to holders of the Connecticut Medical Assistance Program Provider Manual by HP Enterprise Please note, in addition to changes to the professional Services. and technical components, there are 68 codes from the same categories of service outlined above that will also Responsible Unit: DSS, Division of Health Services, have an updated global fee. This update to the global Medical Policy Section; Nina Holmes, Policy fee is necessary because the current fees for the Consultant, (860) 424-5486 professional and technical components, when added together, do not equal the global fee. In order to ensure Date Issued: August 2015 a consistent policy, the Department identified the appropriate year of the Medicare Physician Fee Schedule where the fees for the professional and technical components add up appropriately. This policy change applies to services reimbursed on the Physician Office and Outpatient Fee Schedule and the Physician Surgical Fee Schedule under the HUSKY Health program (HUSKY A, B, C and D) for dates of service September 7, 2015 and forward. Department of Social Services Division of Health Services 55Farmington Avenue Hartford, CT 06105 www.ctdssmap.com The following codes will have updated rates for the professional and technical components only. Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 87164 Dark field examination 26 LAB $10.72 87207 Smear special stain 26 LAB $11.49 88104 Cytopath fl nongyn smears 26 LAB $17.31 88104 Cytopath fl nongyn smears TC LAB $18.52 88106 Cytopath fl nongyn filter 26 LAB $17.31 88106 Cytopath fl nongyn filter TC LAB $30.27 88108 Cytopath concentrate tech 26 LAB $17.31 88108 Cytopath concentrate tech TC LAB $27.20 88112 Cytopath cell enhance tech 26 LAB $36.11 88112 Cytopath cell enhance tech TC LAB $35.89 88120 Cytp urne 3-5 probes ea spec 26 LAB $31.89 88120 Cytp urne 3-5 probes ea spec TC LAB $271.27 88121 Cytp urine 3-5 probes cmptr 26 LAB $28.55 88121 Cytp urine 3-5 probes cmptr TC LAB $227.49 88125 Forensic cytopathology 26 LAB $7.95 88125 Forensic cytopathology TC LAB $4.54 88160 Cytopath smear other source 26 LAB $15.42 88160 Cytopath smear other source TC LAB $17.24 88161 Cytopath smear other source 26 LAB $15.67 88161 Cytopath smear other source TC LAB $20.56 88162 Cytopath smear other source 26 LAB $23.37 88162 Cytopath smear other source TC LAB $19.80 88172 Cytp dx eval fna 1st ea site 26 LAB $18.73 88172 Cytp dx eval fna 1st ea site TC LAB $13.67 88173 Cytopath eval fna report 26 LAB $43.03 88173 Cytopath eval fna report TC LAB $42.27 88177 Cytp fna eval ea addl 26 LAB $13.24 88177 Cytp fna eval ea addl TC LAB $4.32 88182 Cell marker study 26 LAB $23.34 88182 Cell marker study TC LAB $43.94 88300 Surgical path gross 26 LAB $2.54 88300 Surgical path gross TC LAB $11.94 88302 Tissue exam by pathologist 26 LAB $4.44 88302 Tissue exam by pathologist TC LAB $26.94 88304 Tissue exam by pathologist 26 LAB $6.76 88304 Tissue exam by pathologist TC LAB $33.33 88305 Tissue exam by pathologist 26 LAB $23.40 88305 Tissue exam by pathologist TC LAB $43.42 88307 Tissue exam by pathologist 26 LAB $49.59 88307 Tissue exam by pathologist TC LAB $73.95 88309 Tissue exam by pathologist 26 LAB $82.55 88309 Tissue exam by pathologist TC LAB $101.27 88311 Decalcify tissue 26 LAB $7.47 88311 Decalcify tissue TC LAB $3.77 88312 Special stains group 1 26 LAB $16.83 88312 Special stains group 1 TC LAB $39.78 88313 Special stains group 2 26 LAB $7.47 88313 Special stains group 2 TC LAB $34.16 88314 Histochemical stains add-on 26 LAB $14.03 88314 Histochemical stains add-on TC LAB $47.89 88319 Enzyme histochemistry 26 LAB $16.35 88319 Enzyme histochemistry TC LAB $81.09 88323 Microslide consultation 26 LAB $52.08 88323 Microslide consultation TC LAB $34.61 88331 Path consult intraop 1 bloc 26 LAB $37.23 88331 Path consult intraop 1 bloc TC LAB $17.63 88332 Path consult intraop addl 26 LAB $18.25 88332 Path consult intraop addl TC LAB $6.26 88333 Intraop cyto path consult 1 26 LAB $37.71 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 88333 Intraop cyto path consult 1 TC LAB $17.63 88334 Intraop cyto path consult 2 26 LAB $21.70 88334 Intraop cyto path consult 2 TC LAB $10.60 88342 Immunohisto antibody slide 26 LAB $26.20 88342 Immunohisto antibody slide TC LAB $32.82 88346 Immunofluorescent study 26 LAB $26.42 88346 Immunofluorescent study TC LAB $34.61 88347 Immunofluorescent study 26 LAB $25.92 88347 Immunofluorescent study TC LAB $25.16 88348 Electron microscopy 26 LAB $46.73 88348 Electron microscopy TC LAB $279.73 88355 Analysis skeletal muscle 26 LAB $56.52 88355 Analysis skeletal muscle TC LAB $172.78 88356 Analysis nerve 26 LAB $92.95 88356 Analysis nerve TC LAB $94.57 88358 Analysis tumor 26 LAB $29.84 88358 Analysis tumor TC LAB $15.91 88360 Tumor immunohistochem/manual 26 LAB $34.28 88360 Tumor immunohistochem/manual TC LAB $37.42 88361 Tumor immunohistochem/comput 26 LAB $36.89 88361 Tumor immunohistochem/comput TC LAB $65.45 88362 Nerve teasing preparations 26 LAB $67.30 88362 Nerve teasing preparations TC LAB $103.06 88365 Insitu hybridization (fish) 26 LAB $36.24 88365 Insitu hybridization (fish) TC LAB $48.40 88367 Insitu hybridization auto 26 LAB $39.37 88367 Insitu hybridization auto TC LAB $99.49 88368 Insitu hybridization manual 26 LAB $42.43 88368 Insitu hybridization manual TC LAB $63.99 88381 Microdissection manual 26 LAB $33.13 88381 Microdissection manual TC LAB $107.57 91010 Esophagus motility study 26 DEF $38.50 91010 Esophagus motility study TC DEF $96.93 91013 Esophgl motil w/stim/perfus 26 DEF $6.12 91013 Esophgl motil w/stim/perfus TC DEF $8.88 91020 Gastric motility studies 26 DEF $44.04 91020 Gastric motility studies TC DEF $104.85 91022 Duodenal motility study 26 DEF $44.55 91022 Duodenal motility study TC DEF $91.57 91030 Acid perfusion of esophagus 26 DEF $28.26 91030 Acid perfusion of esophagus TC DEF $56.57 91034 Gastroesophageal reflux test 26 DEF $30.03 91034 Gastroesophageal reflux test TC DEF $118.64 91035 G-esoph reflx tst w/electrod 26 DEF $48.83 91035 G-esoph reflx tst w/electrod TC DEF $264.72 91037 Esoph imped function test 26 DEF $30.03 91037 Esoph imped function test TC DEF $69.60 91038 Esoph imped funct test > 1hr 26 DEF $34.28 91038 Esoph imped funct test > 1hr TC DEF $50.70 91040 Esoph balloon distension tst 26 DEF $29.77 91040 Esoph balloon distension tst TC DEF $264.72 91065 Breath hydrogen/methane test 26 DEF $6.05 91065 Breath hydrogen/methane test TC DEF $34.86 91110 Gi tract capsule endoscopy 26 DEF $111.20 91110 Gi tract capsule endoscopy TC DEF $521.84 91111 Esophageal capsule endoscopy 26 DEF $32.68 91111 Esophageal capsule endoscopy TC DEF $464.95 91120 Rectal sensation test 26 DEF $29.46 91120 Rectal sensation test TC DEF $260.25 91122 Anal pressure record 26 DEF $53.29 Procedure Proc description Mod1 Mod1 Rate Rate Effective Code desc Type September 7, 2015 91122 Anal pressure record TC DEF $108.30 91200 Liver elastography 26 DEF $8.87 91200 Liver elastography TC DEF $13.85 92025
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