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CMS-1403-FC
The TC of physician pathology services refers to the
preparation of the slide involving tissue or cells that a
pathologist will interpret. In contrast, the pathologist’s
interpretation of the slide is the PC service. If the PC
service is furnished by the hospital pathologist for a
hospital patient, it is separately billable. If the
independent laboratory’s pathologist furnishes the PC
service, it is usually billed with the TC service as a
combined service.
In the CY 2000 PFS final rule, we stated that we would
implement a policy to pay only the hospital for the TC of
physician pathology services furnished to hospital
inpatients (64 FR 59380, 59408 through 59409). Prior to
this proposal, any independent laboratory could bill the
Medicare contractor under the PFS for the TC of physician
pathology services for hospital inpatients. At the request
of commenters on the final rule that independent
laboratories and hospitals needed sufficient time to
negotiate arrangements, we delayed the implementation of
that rule until 2001.
Section 542 of the Medicare, Medicaid, and SCHIP
Benefits Improvement and Protection Act of 2000
(Pub. L. 106-554) (BIPA) established the billing exception
that allowed certain qualified independent laboratories to
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