#Advanced diagnostic laboratory code

As a result, the test is not considered a hospital outpatient service for which the hospital must bill Medicare and for which the performing laboratory must seek payment from the hospital, but rather a laboratory test under the Clinical Laboratory Fee Schedule for which the performing laboratory must bill Medicare directly. If all of the requirements are met, the DOS of the test must be the date the test was performed, which effectively unbundles the laboratory test from the hospital outpatient encounter. The test was reasonable and medically necessary for the treatment of an illness.The results of the test do not guide treatment provided during the hospital outpatient encounter and.It was medically appropriate to have collected the sample from the hospital outpatient during the hospital outpatient encounter.The specimen was collected from a hospital outpatient during an encounter (as both are defined in 42 CFR 410.2).The test was performed following a hospital outpatient’s discharge from the hospital outpatient department.

#Advanced diagnostic laboratory code

Specifically, under 42 CFR 414.510(b)(5), in the case of a molecular pathology test performed by a laboratory other than a blood bank or center, a test designated by CMS as an ADLT under paragraph (1) of the definition of an advanced diagnostic laboratory test in 42 CFR 414.502, a test that is a cancer-related protein-based MAAA, or the test described by CPT code 81490, the date of service of the test must be the date the test was performed only if: Additionally, in the CY 2021 Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) final rule published December 29, 2020, CMS established another exception to laboratory DOS policy for tests that are cancer-related protein-based Multianalyte Assays with Algorithmic Analyses (MAAAs) or the test described by CPT code 81490. This exception to the laboratory DOS policy was effective beginning on January 1, 2018.

In the CY 2018 Hospital Outpatient Prospective Payment System (OPPS)/Ambulatory Surgical Center (ASC) final rule published December 14, 2017, CMS established another exception to laboratory DOS policy for Advanced Diagnostic Laboratory Tests (ADLTs) and molecular pathology tests excluded from OPPS packaging policy so that the DOS is the date the test was performed, if certain conditions are met. When the “14-day rule” applies, the DOS is the date the test is performed, instead of the date of specimen collection. In general, the date of service (DOS) for clinical diagnostic laboratory tests is the date of specimen collection unless the physician orders the test at least 14 days following the patient’s discharge from the hospital.