Pathology/Lab Coding Alert

Question: We read in a past issue of Pathology/Lab Coding Alert [Vol. 14, No. 3] that we should bill MAAA codes to Medicare using the underlying component tests. Is this still the case?

Ohio Subscriber

Answer: No, that is no longer the case for many CPT® codes that describe multi-analyte assays with algorithmic analyses (MAAAs). Although Medicare initially declined to price any MAAA codes, but instead instructed labs to bill the underlying component tests, the agency changed course for 2015 when it first considered pricing for four MAAA tests.

Now, the Clinical Laboratory Fee Schedule (CLFS) has considered pricing for 16 MAAA codes, and intends to add a new code to the fee schedule in 2017. Many of the codes that CMS priced using the gapfill methodology don’t yet have a payment amount on the current CLFS, because the Medicare Administrative Contractors (MACs) set the payment during the gapfill process.

You’ll find other MAAA codes on the 2016 CLFS with a payment amount based on CMS’s decision to crosswalk the codes, or the completion of the gapfill process as follows (national limit amount):

For codes on the list with no pricing amount, you should bill the code to your MAC and expect contractor pricing. For any MAAA code not on the CLFS, you should contact your MAC for coverage, coding and pricing instruction.