Monday, January 22, 2024

Bad News from Novitas: Nixes Payment on Digital Pathology Codes

Header: AMA has created numerous Category III codes for digital pathology slides (whole slide imaging).  Novitas had a payment-related article in 2023, but has a new NON PAYMENT article in 2024.


AMA has created two large batches of Category III codes for digital pathology.  See CAP:

Initially the codes covered major surgical pathology codes, and for 2024 more codes were created for pretty much any CPT code that creates a slide.   However, I've pointed out in the past some drawbacks.  One, they are add-on codes, so that they must be billed on the same claim same day as the original slide creating code (like 88305).   Second, the codes are bundled, not paid separately, for both Medicare inpatients and outpatients, where  most major specimens originate.

Novitas had an article offering limited payment circumstances.  However, on Jaunary 18, 2024, Novitas issued an update that it had "re-evaluated" these codes and would convert them to non payable status.   (As just mentioned, they were already nonpayable/bundled for hospital outpatients.)

Read the Novitas article below.


Billing for digitization of glass microscope slides, CPT codes 0751T-0763T

Effective for claims received on or after February 19, 2024

Novitas recently re-evaluated the pricing and billing instructions related to the 2024 allowances for CPT codes 0751T-0763T, concluding that these add-on codes were developed for tracking purposes and as such should receive no additional payment. The reporting instructions previously provided for submission of these codes, including requiring information in Box 19, will be retracted as no longer required.

Effective for claims with dates of service on or after February 19, 2024, no additional payment will be made for 0751T-0763T.