Medical Review Service Specific Probe Review on Laboratory Services: HCPCS Codes 80048, 80053, 80061, 80076, 82607, 83036, 83880, 84153, 84439, 84443 and 86141

The J1 Medical Review Department will be performing a service specific probe review of laboratory services. This review will focus on the following laboratory procedure codes: 80048 (Basic Metabolic Panel); 80053 (Comprehensive Metabolic Panel); 80061 (Lipid Panel); 80076 (Hepatic Function Panel); 82607 (Cyanocobalamin- Vitamin B-12); 83036 (Hemoglobin- Glycosylated- A1C); 83880 (Natriuretic Peptide); 84153 (Prostate Specific Antigen- PSA; Total); 84439 (Thyroxine; Free), 84443 (Thyroid Stimulating Hormone- TSH) and 86141 (C-Reactive Protein; High Sensitivity- HSCRP). This probe is a result of claims data analysis which identifies high utilization of these laboratory services.

A sample of 100 claims for each of the following HCPCS codes will be selected from California, Hawaii and Nevada to be included in the probe: 80048, 80053, 80061, 80076, 82607, 83036, 83880, 84153, 84439 and 84439. A sample of 100 claims for HCPCS code 86141 will be selected from California only for review.

If you receive an Additional Development Request (ADR), please return the requested documentation to the J1 Medical Review Department address within 30 days of the date listed on the ADR. Please refer to the Palmetto GBA J1 Web site for ADR instructions and include a copy of the ADR with your response. Results of the probe will be posted to the Palmetto GBA J1 Web site following completion of the review process.