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Notice: This CMS-approved document has been submitted - Philips ... Notice: This CMS-approved document has been submitted - Philips ...
CMS-1403-FC range of samples for G0417, G0418, and G0419 to calculate the average number of samples for each code. We assumed 15 percent of the samples taken require considerable clinical expertise to differentiate and distinguish carcinoma from hyperplasia. We assigned the work and PE values of 88305 to the 15 percent of samples requiring this level of expertise. The remaining 85 percent of samples require confirmation of prostate tissue and interpretation indicating the presence of cancer or not since the diagnosis had been identified in the 15 percent of samples. We assigned the work and PE of 88304 to this group of samples. We assigned the full work and PE payment to the 15 percent sample component to reflect the skill, time, and effort required to identify and diagnose carcinoma. We applied the multiple surgical procedure discount (RVUs were reduced by 50 percent in accordance with current CMS policy) to the remaining 85 percent of samples reviewed for identification and confirmation of prostate tissue. We selected the 75 th percentile of samples from G0416 to recognize the greater degree of skill, time, and effort required to review, identify, and interpret the initial biopsy specimens sampled. (See Addendum B for the values assigned to these G codes.). 142
CMS-1403-FC Note: Under the PFS, CPT code 88305 will continue to be recognized for those surgical pathology services unrelated to prostate needle saturation biopsy sampling. 143
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<strong>CMS</strong>-1403-FC<br />
Note: Under the PFS, CPT code 88305 will continue to<br />
be recognized for those surgical pathology services<br />
unrelated to prostate needle saturation biopsy sampling.<br />
143
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