December 13, 2012
Pathology Service Denials
We have received a number of inquiries from independent labs and pathologists regarding claims denied with CO-96 and remark code N70. This denial indicates pathology services were furnished to a patient who, on the date of service, had an inpatient or outpatient hospital status. Effective July 1, 2012, the technical component (TC) of pathology services furnished to a patient who was an inpatient or an outpatient on that date of service must be billed by the hospital and reimbursed under Medicare Part A.
A moratorium implemented as a result of Section 3006 of the Middle Class Tax Relief and Job Creation Act of 2012 allowed certain practitioners and suppliers to continue to bill Medicare Part B for the TC of physician pathology services furnished to hospital patients. This moratorium expired on June 30, 2012. As a result, the technical component and global pathology services submitted to Medicare Part B deny effective for claims with dates of service July 1, 2012, and after.
Medicare Part B will only reimburse the professional component (interpretation) of these services.
For additional information, please refer to the CMS MLN Matters article MM7767, "Emergency March Update, Middle Class Tax Relief and Job Creation Act of 2012 (MCTRJCA) to the CY 2012 Medicare Physician Fee Schedule (MPFS) Database
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