CBC Widespread Probe Review

on Thursday, 10 September 2009. All News Items

Last week, Cahaba GBA announced their plans to conduct a widespread probe review of CPT 85025, CBC with automated differential for Bill Type 13X.  This review is the result of errors identified by the Comprehensive Error Rate (CERT) program.  According to the release, if a physician’s order is for a CBC with no mention of differential, then it is not appropriate to bill CPT code 85025.  MMP, Inc. surmises that CPT code 85027 would the appropriate code to bill for an order that simply states “CBC.”  MMP, Inc. also surmises that the physician’s order must specify CBC with differential to justify the billing of CPT code 85025.  It is important to note that the Medicare unadjusted reimbursement amount for CPT 85025 is $11.35 and is $6.77 for CPT code 85027.  The notice does not state if Cahaba will deny the complete line item if the test performed does not match the order, or if they will downgrade payment to the appropriate CPT code.  Findings of the review will be posted on Cahaba’s website for providers’ educational purposes.

The complete notification can be viewed at CBC Widespread Review Notice.

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