Laboratory Question for the Week of February 1, 2016

Laboratory Compliance Question of the Week

Question:

Are there any special billing guidelines when a CPT code description includes the terms “screen” or “screening”?

Answer:

According to the Centers for Medicare & Medicaid Services (CMS), the use of these terms in CPT code descriptors does not necessarily describe a test performed in the absence of signs and symptoms of illness, disease or condition. Contractors do not deny a service based solely on the presence of them.

Tests that are performed in the absence of signs, symptoms, complaints, personal history of disease, or injury are not covered except when there is a statutory provision that explicitly covers tests for screening as described.

If a person is tested to rule out or to confirm a suspected diagnosis because the patient has a sign and/or symptoms, this is considered a diagnostic test, not a screening test. Contractors have discretionary authority to make reasonable and necessary scope of benefit determinations, CMS states.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.