#Clinical pathology labs code#
Payment for a CPT code can be split into the “professional component” that covers the physician’s professional service, and the “technical component” that covers the cost of equipment, supplies, and non-physician personnel. This physician-based professional service coding system is also used by payors other than Medicare. The payment for that service is determined by assigning a Common Procedural Terminology (CPT) code, which is a standardized coding system for physician services.
For these professional services, the pathologist examines and interprets the submitted material, such as a gastric biopsy or a cytologic preparation, and produces a report. The most common source of payment, familiar to most pathologists, is the payment mechanism under Medicare for surgical pathology, cytopathology, and certain clinical laboratory tests. So, how do these payment systems work and why do they matter to you? Knowledge of Medicare payment processes is particularly important because private insurers follow some analogous processes, and often set their payment rates as a percent of Medicare’s fee schedules. Under Medicare, the services provided to individual patients are covered as “Part B” (Medical Insurance), while facility and oversight services are covered under “Part A” (Hospital Insurance). Medicare is administered by the federal government’s Center for Medicare and Medicaid Services (CMS). Medicare, the federal health insurance program for people aged 65 and over (and some younger people with certain qualifying disabilities), is the largest single payor for health care services in the United States.
Providing “one on one” professional services to individual patients.Despite variations in practice scenarios and payor relationships, for pathologists there are essentially three ways to earn revenue:
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