CMS is withdrawing NCCI PTP edits between Column One codes 80305, 80306, and 80307 for presumptive test(s), and Column Two codes G0480 – G0483, and G0659 for definitive test(s), according to an announcement posted on the agency’s website and communications from the National Independent Laboratory Association and others.
The edit was initially put in place July 1, 2023, to disallow payment for definitive tests (G0480, G0481, G0482 and G0483) when performed on the same day as the presumptive tests (CPT® codes 80305, 80306, and 80307). Removal of the edit will be reflected in the October 1 release of the NCCI edit file.
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The removal of the edit will be retroactive to July 1, meaning that any claim affected by the procedure-to-procedure (PTP) edit will be processed and paid as appropriate under existing payment and coverage policies.
CMS received feedback from several industry stakeholders who maintained the edit was not in line with standards of care and created access to care issues for patients. Lighthouse hosted a webinar discussing the issue in depth to both help labs navigate this change and draw attention to the restrictions it created.
If you’d like to discuss this issue further or better understand how claims affected by this edit will be processed, feel free to reach out to us for a free consultation.