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- CAP Engages with First Coast, Novitas on New Digital Pathology Code Policy
The CAP requested a meeting with First Coast Service Options, a Medicare Administrative Contract (MAC), servicing providers in Florida, Puerto Rico, and the U.S. Virgin Islands as well as Novitas, providers in DC, Delaware, Maryland, New Jersey, and Pennsylvania, to discuss a new requirement for pathologists to document how the digitization of glass microscope slides is medically reasonable and necessary when submitting claims. According to First Coast, an example of a potentially reasonable and necessary service includes if a slide requires an outside consultation that would normally require mailing of the slide, digitization could potentially be medically reasonable and necessary if either the slide represents the only slide demonstrating the pathology of interest (and loss of the slide would mean loss of irreplaceable material), or the consultation is required urgently and mailing a slide would take too much time and the delay would put the patient’s health at risk.
After August 5, 2023, failure to provide a statement on Item 19 of the CMS-1500 claim to document the need for the digitization of glass microscope slides may result in claims rejected as unprocessable.
The CAP plans to address concerns about these requirements with First Coast Service Options at an upcoming meeting as well as send correspondence outlining how this creates an unnecessary documentation burden on pathologists.