HealthSpring – Policy Changes for Lab Services PDF Print E-mail
Monday, 22 April 2013 00:00

Effective 4/1/13 - Policy and Procedure change.

HealthSpring will deny the claims that are not billed using the following codes see below. Due to CMS requirements that plans must submit value codes associated with the below CPT codes, HealthSpring is specifically excluding from reimbursable in-office laboratory services CPT® codes 83036, 83037, 80061, 83700, 83701, 83704, and 83721. These codes must be referred to a certified and preferred laboratory and may not be performed in-office for compensation.

As a reminder, you may not balance bill or seek recourse against HealthSpring members for denials that occur related to the submission of the above CPT codes.



******URGENT******


If you are currently performing Lab services in your office and choose not to use Quest or CPL, HealthSpring is requiring that you submit all reporting codes corresponding with lab values received on HealthSpring members. Failure to comply with this request using the HealthSpring approved submission guidelines will result in non-payment of lab services performed in your office beginning April 1, 2013.


For the HbA1c Screening Results, the following reporting codes may be used.

CPT II Code Description
3044F Most recent hemoglobin A1c (HbA1c) level  7.0-9.0%

3045F

Most recent hemoglobin A1c (HbA1c) level  7.0-9.0%

3046F

Most recent hemoglobin A1c (HbA1c) level  greater than 9.0%

*Only codes 3044F and 3045F will make the member compliant.

 


For the LDL Screening Results for both diabetics and patients with cardiovascular conditions, the following reporting codes may be used.

CPT II Code Description
3044F Most recent hemoglobin A1c (HbA1c) level  7.0-9.0%

3045F

Most recent hemoglobin A1c (HbA1c) level  7.0-9.0%

3046F

Most recent hemoglobin A1c (HbA1c) level  greater than 9.0%

*Only code 3048F will make the member compliant.


For additional information, please visit the HealthSpring website at http://hsconnect.bravohealth.com or call their Provider Services Department at 1-866-948-8759, Monday through Friday, 8 a.m. to 7 p.m.

 


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