LDX Updates Only, page-2

Publication tables for PLA code reimbursements

https://www.cms.gov/medicare/payment/fee-schedules/clinical-laboratory-fee-schedule-clfs/files

Likely see the 0442u reimbursement rate appear on the next release which would be added for January 2025.

I have searched through all of these and nothing regarding the PLA code for Febridx outside of its 0.00 reimbursement rate.

The only thing of note I found out of searching for any update:







What Is Modifier 26?The professional component is outlined as a physician’s service, which may include technician supervision, interpretation of results, and a written report. To claim only the professional portion of a service, CPT® Appendix A (Modifiers) instructs you to append modifier 26 to the appropriate CPT® code.

Appropriate Usage:To bill for only the professional component portion of a test when the provider utilizes equipment owned by a hospital/facilityTo report the physician’s interpretation of a test, which is separate, distinct, written, and signed

What Is Modifier TC?The technical component includes the provision of all equipment, supplies, personnel, and costs related to the performance of the procedure. The payment for the technical component portion also includes the practice expense and the malpractice expense. To claim only the technical portion of a service, append modifier TC Technical component to the appropriate CPT® code. Fees for the technical component are generally reimbursed to the facility or practice that provides or pays for the supplies, equipment, and/or clinical staff (technicians).

Appropriate Usage:To bill for only the technical component of a testWhen billing both the professional and technical component of a procedure when the technical component was purchased from an outside entity; the provider would bill the professional on one line of service and the technical on a separate line.