College of American Pathologists

  Medicare/Medicaid Resources


Updated January 9, 2008

Advance Beneficiary Notices
Centers for Medicare and Medicaid Services (CMS) Beneficiary Notices Initiative (BNI)

Blood and Tissue
Current Good Tissue Practice for Human Cell, Tissue, and Cellular and Tissue-Based Product Establishments; Inspection and Enforcement (November 18, 2004)
Eligibility Determination for Donors of Human Cells, Tissues, and Cellular and Tissue-Based Products; Final Rule and Notice (May 25, 2004)
Guidance for Industry/Eligibility Determination for Donors of Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps)
Medicare Coverage Issues Manual, Apheresis (Therapeutic Pheresis)

Clinical Laboratory Payment
Clinical Laboratory Information Resource for Medicare (CMS)
2005 Clinical Laboratory Fee Schedule
Payment for New Clinical Laboratory Tests for 2005

Clinical Laboratory Improvement Amendments of 1988
Current CLIA regulations from the Centers for Disease Control and Prevention

Competitive Bidding
Demonstration Project for Competitive Acquisition of Clinical Laboratory Services

Coding Educational Resource Web Guide

Critical Access Hospital Test Payment
Low Osmolar Contrast Material/Laboratory Tests/Payment for Inpatient Services Furnished by a Critical Access Hospital (CAH) (November 26, 2004)

Cytology Proficiency Testing
Informational Supplement (January 26, 2006)
Overview of testing process
Letter to Laboratory Directors (January 31, 2005)
State Survey Agency (SA) Responsibilities in Enforcing the Gynecologic Cytology Proficiency Testing (PT) Requirements under the Clinical Laboratory Improvement Amendments of 1988 (CLIA)(December 16, 2004)

End Stage Renal Disease 50/50 Rule
Emergency Change to Carrier Instructions for the End Stage Renal Disease (ESRD) 50/50 Rule Implementation (Medlearn Matters MM3609)

HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule (January 23, 2004)

Medicare Claims Processing
Common Working File (CWF) Duplicate Claim Edit for Referred Clinical Diagnostic Services and Purchased Diagnostic Services (Medlearn Matters MM 3551)
Program Transmittal: Skilled Nursing Facility (SNF) Consolidated Billing: Services Furnished Under an "Arrangement" With an Outside Entity (May 21, 2004)

Medicare Physician Fee Schedule
Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule for Calendar Year 2005 (November 15, 2004)
How to Calculate Medicare Physician Payment Amounts

Medicare Secondary Payer
Program Transmittal: General Policy (February 27, 2004))

National Correct Coding Initiative
Edits, Column 1/Column 2 Pathology and Laboratory Services, CPT Codes 8000-89999
Edits, Mutually Exclusive Pathology and Laboratory Services, CPT Codes 80000-89999
CLIA Specialties Associated with CPT 88361

National Coverage Determinations
Update of Laboratory NCDs to Reference New Screening Benefits (February 11, 2005)
Procedure for Producing Guidance Documents Describing Medicare's Coverage Process (September 24, 2004)
Medicare Program; Procedures for Maintaining Code Lists in the Negotiated National Coverage Determinations for Clinical Diagnostic Laboratory Services (December 24, 2003)

Negotiated Rulemaking: Clinical Diagnostic Laboratory Services
Coverage and Administrative Policies: pages 58788-58836; pages 58837-58886; pages 58887-58890

Outpatient Prospective Payment System
Changes to the Hospital Outpatient Prospective Payment System for Calendar Year 2005 (CMS)

Pap Tests
Medicare Carriers Manual revisions regarding increased frequency of covered screening Pap tests (February 1, 2001)
Medicare Carrier Manual: Section 4603, Screening Pap tests, diagnosis code required for women without a uterus or cervix (August 31, 2000)

Physician Quality Reporting Initiative
Resource for the 119 Measures in the PQRI Program
CMS PQRI Website
PQRI Audio Conferences