Q&A: Does CMS' lab date of service policy affect Medicare Advantage patients?

Q: Does CMS' molecular pathology/advanced diagnostic laboratory test date of service policy apply to Traditional Medicare only or does it also apply to Medicare Advantage?

A: This policy applies to both Medicare and Medicare Advantage. It's partly a payment policy, but it's also a coverage policy because of the overarching prohibition on unbundling, and most Medicare Advantage contracts for contracted Medicare Advantage plans are usually paying a percentage of Medicare. Now if Medicare is going to pay separately, then they're going to want it billed in that same way so that they can get paid under the Medicare Advantage plan. If it's noncontracted, then you're going to exactly follow fee-for-service billing, so I really think that this does apply to both Medicare and Medicare Advantage plans the same way.

Editor's note: Valerie Rinkle, MPA, CHRI, regulatory specialist for HCPro, a Simplify Compliance brand, answered this question during the HCPro webinar, “New Lab Date of Service Billing Requirements: Strategies for Success,”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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