Notice: This CMS-approved document has been submitted - Philips ...
Notice: This CMS-approved document has been submitted - Philips ... Notice: This CMS-approved document has been submitted - Philips ...
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 828
CMS-1403-FC continue to bill the Medicare contractor under the PFS for the TC of physician pathology services furnished to a hospital patient. In order to bill in this manner, an independent laboratory must have had an arrangement with a hospital in effect as of July 22, 1999 under which the laboratory furnished the TC of the physician pathology service to a hospital patient and submitted claims to the Medicare contractor for payment. This provision was initially effective for 2 years, 2001 through 2002. Through subsequent legislation (that is, section 732 of the MMA, section 104 of the MIEA-TRHCA, section 104 of the MMSEA, and section 136 of the MIPPA), this provision has been extended through December 31, 2009. If the independent laboratory did not qualify under this provision, then it must continue to bill the hospital and receive payment from that hospital. As a result of this provision, the TC of physician pathology services could be paid differently depending on the status of the laboratory. H. Section 141: Extension of Exceptions Process for Medicare Therapy Caps 1. Background Section 1833(g)(1) of the Act applies an annual per beneficiary combined cap beginning January 1, 1999, on outpatient physical therapy and speech-language pathology 829
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<strong>CMS</strong>-1403-FC<br />
continue to bill the Medicare contractor under the PFS for<br />
the TC of physician pathology services furnished to a<br />
hospital patient. In order to bill in this manner, an<br />
independent laboratory must have had an arrangement with a<br />
hospital in effect as of July 22, 1999 under which the<br />
laboratory furnished the TC of the physician pathology<br />
service to a hospital patient and <strong>submitted</strong> claims to the<br />
Medicare contractor for payment. <strong>This</strong> provision was<br />
initially effective for 2 years, 2001 through 2002.<br />
Through subsequent legislation (that is, section 732<br />
of the MMA, section 104 of the MIEA-TRHCA, section 104 of<br />
the MMSEA, and section 136 of the MIPPA), this provision<br />
<strong>has</strong> <strong>been</strong> extended through December 31, 2009. If the<br />
independent laboratory did not qualify under this<br />
provision, then it must continue to bill the hospital and<br />
receive payment from that hospital. As a result of this<br />
provision, the TC of physician pathology services could be<br />
paid differently depending on the status of the laboratory.<br />
H. Section 141: Extension of Exceptions Process for<br />
Medicare Therapy Caps<br />
1. Background<br />
Section 1833(g)(1) of the Act applies an annual per<br />
beneficiary combined cap beginning January 1, 1999, on<br />
outpatient physical therapy and speech-language pathology<br />
829