CPT Code for CD4/CD8

Phil McCoy pmccoy at UMDNJ.EDU
Thu Sep 14 18:36:07 EST 2000


A major element here is whether you are dealing with inpatients or
outpatients. The payments for these two groups are structured very
differently. In terms of outpatients, who we are often discussing when
we look at fee-for-service and specific CPT-encoded billing, different
institutions operate in vastly different manners. SOP used to be that
the hospital collects the technical and the pathologists collect the
professional component. However, if you look at what state Medicaid
agencies pay for the TC vs the PC (subject of a paper of mine in press),
you will see that the TC is often insufficient to cover even the cost of
the test. Thus, "renegotiations" take place between the hospitals and
the pathologists. It becomes very political at that point.
Essentially...bottom line (literally)...there are no set rules here
(just don't double bill for God's sake).

Phil




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