Laboratory Question for the Week of November 2, 2015

Laboratory Compliance Question of the Week


For 2016, will all outpatient lab tests be packaged as previously?


In the 2016 proposed outpatient prospective payment system (OPPS) rule, the Centers for Medicare & Medicaid Services state that outpatient lab tests would be “conditionally” packaged regardless of the date of service (DOS) on a claim with a service that is assigned status indicator (SI) “S,” “T,” or “V” unless an exception applies or the laboratory test is “unrelated” to the other hospital outpatient department service or services on the claim. It proposed new status indicator (SI) “Q4” for this purpose. When laboratory tests are the only services on the claim, a separate CLFS payment rates would be made. The “L1”modifier would still be used for “unrelated” laboratory tests, CMS states.

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