Effective January 1, 2013, the CPT coding for molecular pathology services will change based on new CPT codes created by the American Medical Association (AMA).  Previously a single molecular pathology service was billed using a combination of multiple CPT codes and multiple units of service.  The 127 new CPT molecular pathology codes specify the gene and variant being tested and will affect approximately 200 tests offered by the Department of Pathology in Molecular Pathology and Mailouts. The UIHC Laboratory Services Handbook (http://www.healthcare.uiowa.edu/path_handbook/) will be updated to include both the old and new CPT codes for the tests.  Tests performed on specimens collected in 2012 will use the original CPT codes and tests performed on specimens collected in 2013 will use the new CPT codes.  The charges for laboratory tests visible in Epic order entry will also be updated.

For Mailouts tests, if a reference laboratory offers a direct bill to insurance option for the test, information will be provided in EPIC to facilitate utilizing this option.  Reference labs that offer direct bill services can be contacted to assist with CPT coding, pre-authorizations, and estimates of patient liability.  Providers will need to complete the reference laboratory requisition and obtain a copy of the patient’s insurance card (both front and back) prior to sending specimens to Mailouts for processing.

If you have questions about the CPT codes for molecular pathology, please contact the Department of Pathology via e-mail at PathologyPricing-Billing@healthcare.uiowa.edu or contact Aaron Bossler, MD, PhD, Medical Director of Molecular Pathology (4-9566 or aaron-bossler@uiowa.edu) or Matthew Krasowski, MD, PhD, Director of Clinical Laboratories (4-9380 or matthew-krasowski@uiowa.edu).