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LAB Table (Clinical Diagnostic Lab Fee Schedule
CLAB)
The Clinical Lab fee schedule contains national limits and pricing amounts for each procedure code subject to the Clinical Lab fee schedule payment methodology.
HCPCS CODE
All current year active and deleted CPT and alpha-numeric codes subject to the Clinical Laboratory Fee Schedule.
MODIFIER
Where modifier is shown, QW denotes a CLIA waiver test.
60% NATIONAL LIMITATION AMOUNT
The 60% National Limitation Amount is set at 74% of the 2003 median. The 62% National Limitation Amount can be computed using the following algorithm:
(60% National Limitation Amount / .60) * .62
If the floor is applicable, then the National Limitation Amount is appropriately adjusted.
60% MEDIAN
Median of the 2003 60% Updated Base Fee Amounts from all Medicare Part B Carriers.
60% FLOOR
BBRA of 1999 requires a payment floor of $14.60 for all Pap Smears; the 62% floor equals the 60% floor.
Notes:
(1) The 60% Pricing Amount is the lower of the National Limitation Amount or the Updated Base Fee Amount. If the floor is applicable, then the pricing amount is appropriately adjusted.
(2) The 62% Pricing Amount can be computed using the following algorithm: (60% Pricing Amount / .60) * .62) If the floor is applicable, then the pricing amount is appropriately adjusted.
STATES:
CARRIER 00510 (ALABAMA) 60% PRICING AMOUNT
CARRIER 00511 (GEORGIA) 60% PRICING AMOUNT
CARRIER 00512 (MISSISSIPPI) 60% PRICING AMOUNT
CARRIER 00520 (ARKANSAS) 60% PRICING AMOUNT
CARRIER 00521 (NEW MEXICO) 60% PRICING AMOUNT
CARRIER 00522 (OKLAHOMA) 60% PRICING AMOUNT
CARRIER 00523 (MISSOURI GENERAL AMERICAN) 60% PRICING AMOUNT
CARRIER 00528 (LOUISIANA) 60% PRICING AMOUNT
CARRIER 00590 (FLORIDA) 60% PRICING AMOUNT
CARRIER 00591 (CONNECTICUT) 60% PRICING AMOUNT
CARRIER 00630 (INDIANA) 60% PRICING AMOUNT
CARRIER 00650 (KANSAS) 60% PRICING AMOUNT
CARRIER 00655 (NEBRASKA) 60% PRICING AMOUNT
CARRIER 00660 (KENTUCKY) 60% PRICING AMOUNT
CARRIER 00740 (MISSOURI) 60% PRICING AMOUNT
CARRIER 00751 (MONTANA) 60% PRICING AMOUNT
CARRIER 00801 (WESTERN NEW YORK) 60% PRICING AMOUNT
CARRIER 00803 (EMPIRE NEW YORK) 60% PRICING AMOUNT
CARRIER 00805 (NEW JERSEY) 60% PRICING AMOUNT
CARRIER 00820/01 (NORTH DAKOTA) 60% PRICING AMOUNT
CARRIER 00820/02 (SOUTH DAKOTA) 60% PRICING AMOUNT
CARRIER 00824 (COLORADO) 60% PRICING AMOUNT
CARRIER 00825 (WYOMING) 60% PRICING AMOUNT
CARRIER 00826 (IOWA) 60% PRICING AMOUNT
CARRIER 00831 (ALASKA) 60% PRICING AMOUNT
CARRIER 00832 (ARIZONA) 60% PRICING AMOUNT
CARRIER 00833 (HAWAII) 60% PRICING AMOUNT
CARRIER 00834 (NEVADA) 60% PRICING AMOUNT
CARRIER 00835 (OREGON) 60% PRICING AMOUNT
CARRIER 00836 (WASHINGTON STATE) 60% PRICING AMOUNT
CARRIER 00865 (PENNSYLVANIA) 60% PRICING AMOUNT
CARRIER 00870 (RHODE ISLAND) 60% PRICING AMOUNT
CARRIER 00880 (SOUTH CAROLINA) 60% PRICING AMOUNT
CARRIER 00883 (OHIO) 60% PRICING AMOUNT
CARRIER 00884 (WEST VIRGINIA) 60% PRICING AMOUNT
CARRIER 00900 (TEXAS) 60% PRICING AMOUNT
CARRIER 00901 (MARYLAND) 60% PRICING AMOUNT
CARRIER 00902 (DELAWARE) 60% PRICING AMOUNT
CARRIER 00903 (DISTRICT OF COLUMBIA) 60% PRICING AMOUNT
CARRIER 00904 (VIRGINIA) 60% PRICING AMOUNT
CARRIER 00910 (UTAH) 60% PRICING AMOUNT
CARRIER 00951 (WISCONSIN) 60% PRICING AMOUNT
CARRIER 00952 (ILLINOIS) 60% PRICING AMOUNT
CARRIER 00953 (MICHIGAN) 60% PRICING AMOUNT
CARRIER 00954 (MINNESOTA) 60% PRICING AMOUNT
CARRIER 00973 (PUERTO RICO) 60% PRICING AMOUNT
CARRIER 05130 (IDAHO) 60% PRICING AMOUNT
CARRIER 05440 (TENNESSEE) 60% PRICING AMOUNT
CARRIER 05535 (NORTH CAROLINA) 60% PRICING AMOUNT
CARRIER 14330 (NEW YORK GHI) 60% PRICING AMOUNT
CARRIER 31140 (NORTHERN CALIFORNIA) 60% PRICING AMOUNT
CARRIER 31142 (MAINE) 60% PRICING AMOUNT
CARRIER 31143 (MASSACHUSETTS) 60% PRICING AMOUNT
CARRIER 31144 (NEW HAMPSHIRE) 60% PRICING AMOUNT
CARRIER 31145 (VERMONT) 60% PRICING AMOUNT
CARRIER 31146 (SOUTHERN CALIFORNIA OCCIDENTAL) 60% PRICING
Multi Schedule States
State Carriers
CA1 31146
CA2 31140
MO1 00740
MO2 00523
NY1 00801
NY2 00803
NY3 14330
To find a carrier's locality description select the RBRVS table on the main screen, click on the large RBRVS button, select the change locality button and select a state.
GAP FILL INDICATOR
0--No Gap Filling Required
1--Carrier Needs to Gap Fill 60% and 62% Fee Schedules
Additional Notes on the LAB Table. In order to facilitate the distribution of pricing information for specimen collection services, this file contains pricing information for codes G0001, P9610, and P9612. CPT codes 80002 through 80019 for 1 through 19 non-specified automated multi-channel test and codes G0058-G0060 for 20-22 or more tests were deleted in 1998 and replaced by a new series of parallel HCFA payment codes (ATP02-ATP22). Instructions on the 2003 Clinical Diagnostic Laboratory Fee Schedule and Laboratory Services Paid Under Reasonable Charge Payment Methodology ere issued in Program Memorandum AB-02-163.
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