Resolved: Reference Lab and Anti-Markup Payment Limitation Services

Issue Identified March 8, 2019

In the fall of 2016, The Centers for Medicare & Medicaid Services (CMS) became aware of an issue concerning numerous rejections of services related to the October 1, 2016, implementation of the MCS Edits for reference lab and anti-markup payment limitation services. The edits were deactivated in November 2016. In February of 2019, CMS instructed Medicare Administrative Contractors (MACs) to reactivate these edits. Since the reactivation, CMS is aware that two of the four edits (edits 088L and 089L) continue to create a burdensome volume of claim returns.

Provider Action: CMS has instructed MACs to disable/turn off these two edits and this task has been completed. For fastest reimbursement, providers may resubmit their previously returned claims related to this issue. Should a provider bring a claim to our attention rather than resubmitting, the claim will be reopened. CMS will provide further instructions regarding these edits at a later date. 

4/2/2019 Resolved: Providers may resubmit their previously returned claims related to this issue.

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