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Printed Date: 9/22/2015
Answer: Beginning in calendar year (CY) 2014, payment for most laboratory tests (except for molecular pathology tests) will be packaged under the Outpatient Prospective Payment System (OPPS). The general rule for OPPS hospitals is laboratory tests should be reported on a 13x TOB. There are limited circumstances described below in which hospitals can separately bill for laboratory tests. For these specific situations the Centers for Medicare & Medicaid Services (CMS) expanded the use of the 14x TOB to allow separate billing and payment at CLFS rates for hospital outpatient laboratory tests.
Laboratory tests may be (or must be for a non-patient specimen) billed on a 14x TOB in the following circumstances:
It will be the hospital’s responsibility to determine when laboratory tests may be separately billed on the 14X claim under these limited exceptions. In addition, laboratory tests for molecular pathology tests described by CPT codes in the ranges of 81200 through 81383, 81400 through 81408, and 81479 are not packaged in the OPPS and should be billed on a 13X type of bill.
Reference: Change Request (CR) 8572 (PDF, 265 KB)
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Last Updated: 07/23/2020