863XX & 873XX are two new CPT Codes For Clinical Lab Test

James Smith
August 7, 2011 — 1,389 views  
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As we get ready to enter the final quarter of this year, the talk that's taking center stage now is the CPT 2012 code changes.

 Two new 2012 CPT codes made its debut at the annual CMS laboratory public meeting for pricing new test codes for payment on the clinical laboratory fee schedule (CLFS). One of them is if your lab runs a single-result test for HIV-1 antigens and HIV-1/HIV-2 antibodies, you'll have a new code to use in the coming year.

 More on the horizon? Not really. This year there were five codes on the agency's 'reconsideration request' list. Even though this year's meeting featured much discussion about drug test coding there were no new codes on the horizon.

In the coming year, you can expect these two just-in clinical lab test codes (although numbering is yet to be determined). These codes will provide more specific reporting for newer tests you may have added to your menu.



  • 863XX -- Nuclear Matrix Protein 22 (NMP22), qualitative



  • 873XX -- HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result



Drug Testing                                               
Apart from pricing recommendations for the just-in codes, the agency heard public comments for reconsideration requests for these CPT codes 2011: G0434, G0435, 86481

 Drug screen: Many commentators suggested altering G0434 to include only CLIA waived tests while coming up with a new CPT code for moderate complexity tests priced at four times G0434. The present grouping under G0434 fines clinical labs that carry out these tests using instrumented moderate complexity systems. This instrument provides clinical advantages like higher specificity that commentators said shouldn't be disheartened by coding and reimbursement. 

Pricing proposal
The agency received industry input during the July 18, 2011 public meeting for the new codes. You can get CMS's proposed payments at www.cms.gov/ClinicalLabFeeSched/ and you can make comments on the recommended pricing. The agency will post final payment determinations on the same website in October this year.

Almost everyone at the public meeting expressed their willingness for crosswalks for the new CPT codes.

 The AMA proposed 101 new CPT 2012 codes for molecular assays in cancer, genetics and histocompatibility all right, however CMS will not consider setting prices for those codes on the CLFS in 2012 since they were not under consideration at the public meeting.
For more CPT Coding news and updates for the ensuing year, sign up for a good Medical Coding resource like SuperCoder.

James Smith

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