CMS Transmittal Resolves Madcap Federal Register Errors on Date of Service 2018: Ignore CMS Errors

In final rulemaking for CY2018, CMS revised its date of service rules for hospital outpatient biopsies, in a manner that requires the performing laboratory to bill for molecular tests.   This may be the hospital's own molecular lab but often may be an outside independent lab. 

However, CMS did some really weird twists, turns, and misstatements in finalizing the rule.  For example, they stated point blank it referred to "molecular pathology tests" and equally point blank it did not apply to "genomic sequencing procedures or PLA tests."    This is like saying a rule applies to household pets, including cats and dogs, except not dogs. 

In producing its operating instructions to providers and MACs, on December 22, 2017, CMS simply ignored the weirder misstatements in its own rule and provides simple instructions.   If it's a molecular pathology test, then it has "OPPS Status Indicator A" in a policy spreadsheet called Appendix B which is mainly issued annually but gets small updates quarterly.   See the CMS webpage, "Addendum B Updates," here.

If the CPT code is paired with Status Indicator A, then that CPT code is billed by the providing lab (be it hospital or independent.) 

See Medline Matters MM10417, here.   See also Instructions to Contractors, CR10417 (Transmittal CP3941), here.

They left one quirk, which is that the new DOS for Status "A" tests is "the date they are performed."  Is that the date they are signed out?   Probably?  We think?   CMS declined to specify for us, and even declined to say it was in fact the date of sign out or the date of final report, it's "the date they are performed" whatever that is (rule, pp 52538-9). 

See new 2018 regulation at 42 CFR 414.510 here.  For final rulemaking, see 82 FR 52533ff, here.