CPT Codes for Molecular Pathology

effective January 1, 2013

On January 1, 2013, the American Medical Association’s (AMA) new molecular CPT codes will go into effect for purposes of Medicare reimbursement claims. As such, the stacking codes presently being suggested in Mayo Medical Laboratories' test catalog will be updated to reflect our coding suggestions for the impacted molecular tests based on the new codes.

All coding and billing changes associated with the new codes will be reflected in the Mayo Medical Laboratories Client Price Portal effective January 1, 2013.

The new codes will impact our clients in two ways:

CPT Coding Updates	Billing Updates
Slightly more than 200 Mayo Medical Laboratories tests will be impacted by the code updates. The Excel file below lists all Mayo Medical Laboratories tests and orderable codes impacted by the change, the corresponding stacking code suggestions (valid through 2012), and the new CPT code suggestion (effective 2013).	With the elimination of code stacking, Mayo Medical Laboratories must now bill for all elements of a test’s performance under a single CPT code. Because of this change, certain components of test performance which were previously billed separately will now be rolled into the billing of the test.

 

View 2013 CPT Code Changes

Palmetto GBA, a third-party administrator of Medicare that processes all claims for California, Nevada, and Hawaii, is requiring a McKesson Z-Code or a Palmetto Test Indicator (PTI) code to identify molecular diagnostic tests and to determine coverage and reimbursement. Mayo Medical Laboratories has applied for and been granted by Palmetto the attached list of PTI codes for use on our molecular diagnostic tests.

View Palmetto Test Indicators for our Molecular Pathology Tests