CSHCN Services Program 2010 > Laboratory Services > Benefits, Limitations, and Authorization Requirements

   
 

24.2.6 Cytopathology of Vaginal, Cervical, and Uterine Sites

Because of the technical nature of processing and interpreting a Pap smear or specimen for cytopathology, pathologists are the only physician specialty reimbursed with the following exception:

Exception: Other physician specialties equipped to perform Pap smears in their offices must have modifier SU on the claim form.

Procurement and handling of the Pap smear or specimen for cytopathology is considered part of the evaluation and management of the client and is not reimbursed separately.

A pathologist must report the place of service (POS) according to where the Pap smear is interpreted: office (POS 1), inpatient (POS 3), outpatient (POS 5), or independent laboratory (POS 6).

The following procedure codes are payable for gynecological cytopathology services and may be reimbursed only to pathologists and CLIA-certified laboratories whose directors providing technical supervision of cytopathology services are pathologists:

Procedure Codes

88142

88143

88147

88148

88150

88152

88153

88154

88155

88164

88165

88166

88167

88174

88175

Procedure codes 88155 is an add-on code to be used in conjunction with the following cytopathology procedure codes:

Procedure Codes

88142

88143

88147

88148

88150

88152

88153

88154

88164

88165

88166

88167

88174

88175

The interpretation portion of any gynecological cytopathology test must be reported using only procedure code 88141 and type of service "I." Reimbursement is restricted to laboratories and pathologists. The interpretation portion may be reimbursed in addition to the following cytopathology procedure codes:

Procedure Codes

88142

88143

88147

88148

88150

88152

88153

88154

88164

88165

88166

88167

88174

88175


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