Laboratory Question for the Week of March 13, 2017

Laboratory Compliance Question of the Week


When it comes to panels, does Medicare allow labs to substitute one test for another?


The test composition of the panels at your facility must be exactly as stated in the CPT manual. You may not substitute one test for another, nor add to or subtract from those listed. Performance of fewer than the specified tests listed in the panel whose code you report is considered up-coding and a major compliance issue. Performance of more than the specified tests listed for a panel could lead to concerns about inducement or questions concerning the tests’ medical necessity.

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.