100-04 Medicare Claims Processing Manual: Chapter 16 Crosswalk

Medicare Claims Processing Manual
Chapter 16 - Laboratory Services
Crosswalk
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16 	10 	B3-2070,
B3-2070.1,
B3-2020.1,
B3-5114
Background
16 	10.1 	B3-2070.1,
B3-2070.1B
RHC-406.4 	Definitions
16 	10.2 	AB-03-076 	General Explanation of Payment
(no X ref, new section added to summarize subject)
16 	20 	A3-3628 	B3-5114.1 	AB-98-7 	Calculation of Payment Rates - Clinical Laboratory
Fee Schedules
16 	20.1 	A3-3628 	B3-5114.1 	AB-98-7 	Initial Development of Lab Fee Schedules
16 	20.2 	A3-3628 	B3-5114.1 	AB-98-7 	Annual Fee Schedule Updates
16 	30 	A3-3628 	B3-5114,
B3-5114.1
HO-437 	Special Payment Considerations
16 	30.1 	B3-5114.1 	Mandatory Assignment for Laboratory Tests
16 	30.1.1 	A-99-8,
A-00-30
RHCs
16 	30.2 	A3-3215 	B3-2462,
B3-5114.1
HHA-160 	Deductible and Coinsurance Application for
Laboratory Tests

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16 	30.3 	A3-3628 	B3-5114 	A-01-03 	HO-437 	Method of payment for Clinical Laboratory Tests -
Place of Service Variation
16 	30.4 	B3-5114 .2 	Payment for Review of Laboratory Test Results by
Physician
16 	40 	Billing for Clinical Laboratory Tests
16 	40.2 	B3-15048 	Payment Limit for Purchased services
16 	40.3 	A3-3628 	A-01-31 	HHA-437 	Hospital Billing Under Part B
16 	40.3.1 	A3-3137.1 	B3-5114.1 	HHA-437,
SNF-541,
Critical Access Hospital Outpatient Laboratory Service
16 	40.4 	A3-3137.1 	B3-5114.1 	SNF-541,
HO-437
Special SNF Billing Exceptions for Laboratory Tests
16 	40.4.1 	A3-3137.1 	B3-5114.1 	SNF-541,
HO-437
Which Contractor to Bill for Laboratory Services
Furnished to a Medicare Beneficiary in a SNF
16 	40.5 	A3-3628 	Rural Health Clinic Billing
16 	40.6 	B3-4270.2 	AB-98-7 	PRM1 2711 	Billing for ESRD related Laboratory Tests -
Hemodialysis, Intermittent Peritoneal Dialysis, and
Continuous Cycling Peritoneal Dialysis Tests
16 	40.6.1 	B3-4270.2 	AB-98-7,
A-03-033
PRM1 2711 	Claims Processing for Separately Billable Tests for
ESRD Beneficiaries
16 	40.6.1.1 	B3-4270.2 	AB-98-7 	PRM1 2711 	Automated Profile Tests
16 	40.6.1.2 	B3-4270.2 	AB-98-7 	PRM1 2711 	Separately Billable ESRD Lab Tests Furnished by
Hospital-Based Facilities
16 	40.6.13 	B3-4270.2 	AB-98-7 	PRM1 2711 	Separately Billable ESRD Laboratory Tests Furnished
to Patients of Independent Dialysis Facilities
16 	40.7 	B3-5114.1 	Billing for Noncovered Clinical Lab Tests

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16 	50 	B3-4110,
B3-5114.1
Claims Processing
16 	50.1 	B3-5114.1 	Referring Laboratories
16 	50.2 	B3-4110.2 	Physicians
16 	50.2.1 	B3-4110.2 	Assignment Required
16 	50.3 	B3-4110.1 	Hospitals
16 	50.3.1 	B3-4110.1 	Hospital-Leased Laboratories
16 	50.3.2 	B3-4110.5 	HO-460 	Hospital Laboratory Services Furnished to Non-
hospital Patients
16 	50.4 	B-97-12 	Reporting of Pricing Localities for Clinical Laboratory
Services
16 	50.5 	B3-3102 	Jurisdiction of Laboratory Claims
16 	50.5.1 	B3-3102,
B3-5114
Referral Laboratory Services
16 	50.5.2 	B3-3102 	Examples of Independent Laboratory Jurisdiction
16 	60 	B3-5114.1 	Specimen Collection Fee and Travel Allowance
16 	60.1 	A3-3628 	B3-5114.1 	Specimen Collection Fee
16 	60.1.1 	A3-3628 	B3-5114.1 	HO-437 	Physician Specimen Drawing
16 	60.1.2 	A3-3628 	B3-4110.4 	HO-437 	Independent Lab Specimen Drawing
16 	60.1.3 	A3-3644.1 	B3-4270.2 	PR 2711.1,
RDF-322
Specimen Drawing for Dialysis Patients
16 	60.1.4 	A3-3644.1 	B3-4270.2 	PR 2711.1,
RDF-322
Coding Requirements for Specimen Collection

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16 	60.2 	A3-3628.F 	B3-5114.1 	AB-99-49 	HO-437 	Travel Allowance
16 	70 	A3-3628.2 	B-97-3 	RHC-640,
ESRD-322,
HO-306,
HHA-465,
SNF-541,
HO-437.2
Clinical Laboratory Improvement Amendments
(CLIA) Requirements
16 	70.1 	A3-3628.2 	B-97-4 	Background
16 	70.2 	A3-3628.2 	B-97-4 	Billing
16 	70.3 	A3-3628.2 	Verifying CLIA Certification
16 	70.4 	A3-3628.2D 	CLIA Numbers
16 	70.5 	A3-3628.2 	CLIA Categories and Subcategories
16 	70.6 	A3-3628.2E 	Certificate for Physician-Performed Microscopy
Procedures
16 	70.7 	Deleted - held for expansion
16 	70.8 	A3-3628.2F 	AB-01-95 	Certificate of Waiver
16 	70.9 	A3-3628.2F 	CLIA License or Licensure Exemption
16 	70.10 	A3-3628.2F 	CLIA Number Submitted on CMS-1500 Form
16 	70.10.1 	A3-3628.2F 	Physician Notification of Denials
16 	70.11 	A3-3628.2F 	Reasons for Denial - Physician Office Laboratories
Out-of-Compliance
16 	80 	Issues Related to Specific Tests - Header only
16 	80.1 	Screening Services

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16 	80.2 	A3-3628.1 	B3-4603.1,
B3-4180
AB-98-22,
B-98-16,
A-98-6,
AB-97-24
SNF-541.1,
HO-437.1,
RHC-437,
CIM 50.20.1,
R103.CIM
Anatomic Pathology Services
16 	80.2.1 	AB-02-177 	Technical Component (TC) of Physician Pathology
Services to Hospital Patients
16 	80.3 	PM AB-99-84,
AB-99-99
National Minimum Payment Amounts for Cervical or
Vaginal Smear Clinical Laboratory Tests
16 	80.4 	B3-5114.1 	Oximetry
16 	90 	B3-5114 	Automated Profile Tests and Organ/Disease Oriented
Panels
16 	90.1 	A3-3628 	B3-5114 	HO-437 	Laboratory Tests Utilizing Automated Equipment
16 	90.1.1 	A3-3628 	B3-5114 	AB-97-5, AB-97-
7, AB-97-17
HO-437 	Automated Test Listing
16 	90.2 	A3-3628 	B3-5114 	HO-437 	Organ or Disease Oriented Panels
16 	90.3 	AB-97-17 	Claims Processing Requirements for Panel and Profile
Tests
16 	90.3.1 	AB-97-17 	History Display
16 	90.3.2 	AB-97-17 	Medicare Secondary Payer
90.4 	B-98-1 	Evaluating the Medical Necessity for Laboratory Panel
CPT Codes
16 	90.5 	AB-97-17 	Special Processing Considerations
16 	100 	A3-3628 	B3-5114.1 	HO-437 	CPT Codes Subject to and Not Subject to the Clinical
Laboratory Fee Schedule

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16 	100.1 	Deleted - held for expansion
16 	100.2 	A3-3628 	B3-5114.1 	HO-437 	Laboratory Tests Never Subject to Fee Schedule
16 	100.3 	A3-3628 	B3-5114.1 	HO-437 	Procedures Not Subject to Fee Schedule When Billed
With Blood Products
16 	100.4 	A3-3628 	B3-5114.1 	HO-437 	Not Otherwise Classified Clinical Laboratory Tests
16 	100.5 	Other Coding Issues - Header only
16 	100.5.1 	AB-98-7 	Tests Performed More Than Once on the Same Day
16 	100.6 	A-03-033 	Pricing Modifiers
16 	110 	Coordination between Carriers and Other Entities -
Header only
16 	110.1 	B3-5114.1 	Coordination between Carriers and
Intermediaries/RRB
16 	110.2 	B3-5114.1 	Coordination with Medicaid
16 	110.3 	A3-3628 	HO-437 	Coordination with Intermediaries and Providers
16 	110.4 	B3-2070.1F 	Carrier Contacts with Independent Clinical
Laboratories
16 	120 	AB-02-129 	Clinical Laboratory Services Based on the Negotiated
Rulemaking
16 	120.1 	AB-02-129,
B-03-045
Negotiated Rulemaking Implementation