Coding Consultant Uses Crowdsourcing for Clinical Pathology Laboratories to Post Amounts Paid by Medicare Contractors for Molecular Test Claims

Medical laboratories have yet to learn how much to expect in payment for molecular pathology test claims submitted to the Medicare program

Concern is rising among pathologists and clinical laboratory directors about what the Medicare program will pay this year for the 104 new molecular test CPT codes. These new CPT codes became effective on January 1, 2013.

Few–if any–medical laboratories have received payments for Medicare claims submitted early in January. That’s because contractors for the federal Centers for Medicare & Medicaid Services (CMS) are just beginning to process those invoices. The first payments for these molecular test claims are expected within the next several weeks.

Help for Clinical Laboratories and Pathology Groups

To help clinical labs and pathology groups address this problem, CodeMap, LLC, a billing and coding consulting company in Schaumburg, IL, is encouraging clinical labs to post the payment amounts for the molecular test claims they get from the nation’s Medicare Administrative Contractors on the CodeMap website at CodeMap then will make this information available to participating medical laboratories and the public.

crowdsourcing graphic

To fill the knowledge vacuum that exists as different Medicare Administrative Contractors use the gap-fill method to develop reimbursement for the 104 new molecular test CPT codes, CodeMap, LLC, of Schaumburg, IL, is using the crowdsourcing solution. Also known as distributed problem solving, CodeMap is inviting clinical laboratories and pathology groups to voluntarily provide data about their payments for Medicare claims involving the new molecular test codes. (Graphic by