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Follow the new pricing information for the 2008 Laboratory Fee Schedule

APCs Weekly Monitor, January 4, 2008

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QUESTION: Where can I find the 2008 Laboratory Fee Schedule?

ANSWER: Although this question is not APC-related, it does cover an issue that affects outpatient facility coding, billing, and payment, so we will address it in this week's APCs Weekly Monitor.

The Laboratory Fee Schedule will remain frozen (i.e., 2003 levels) through 2008, which is the final year of the congressionally mandated five year freeze.

The 2008 travel allowance to collect specimens from nursing home or homebound patients is: P9603, $0.935 per mile (round to $0.94, if necessary) P9604, $9.35 per flat rate trip basis. The clinical laboratory travel codes are billable only for traveling to perform a specimen collection for either a nursing home or homebound patient.

Mapping information

The Laboratory Fee Schedule lists new code 80047 (Basic metabolic panel [calcium, ionized]) at the same rate as code 80048 with final payment determined by the Automated Multi-Channel Chemistry (AMCC) Panel Payment Algorithm. Along with this code, the Fee Schedule lists the following new codes: 

• New code 82310QW is priced at the same rate as code 82310;
• New code 82565QW is priced at the same rate as code 82565;
• New code 82610 (Cystatin C) is priced at the same rate as code 83883;
• New code 83655QW is priced at the same rate as code 83655;
• New code 83993 (Calprotectin, fecal) is priced at the same rate as code 83631;
• New code 84704 (Gonadotropin, chorionic (hCG); free beta chain) is priced at the same rate as code 84702;
• New code 86356 (Mononuclear cell antigen, quantitative [e.g., flow cytometry] not otherwise specified, each antigen) is priced at the same rate as code 86361;
• New code 87500 (Vancomycin resistance [e.g., enterococcus species van A, van B] amplified probe technique) is priced at the same rate as code 87641;
• New code 87809 (Infectious agent antigen detection by immunoassay with direct optical observation; Adenovirus) is priced at the same rate as code 87802;
• New code 89321QW is priced at the same rate as code 89321;
• New code 89322 is priced at the sum of the rates of codes 89320 and 85007;
• New code 89331 is priced at the sum of the rates of codes 89320 and 87015; and
• New AMCC code ATP23 is priced at the same rate as code ATP22.

Organ or disease-oriented panel codes

Similar to prior years, CMS derived the 2008 pricing amounts for certain organ or disease panel codes and evocative/suppression test codes by summing the lower of the fee schedule amount or the National Limitation Amount for each individual test code included in the panel code.

The CPT Editorial Panel has created code 80047 (Basic metabolic panel [calcium, ionized]), which is an AMCC code. New code 80047 is not a replacement for code 80048 (Basic metabolic panel). Code 80047 is comprised of eight component test codes, including:

• Calcium, ionized (code 82330);
• Carbon Dioxide (code 82374);
• Chloride (code 82435);
• Creatinine (code 82565);
• Glucose (code 82947);
• Potassium (code 84132);
• Sodium (code 84295); and
• Urea Nitrogen (code 84520).

Note that you cannot bill code 80047 for services ordered through an End Stage Renal Disease (ESRD) facility. You must report all services ordered through an ESRD facility individually-not in an organ disease panel.

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