CMS Pub. 100-04, ch. 16, § 80.2

A3-3628.1, SNF 541.1, HO-437.1, RHC-437, CIM 50.20.1, PM AB-98-7, AB-98-22,

B-98-16, A-98-6, R103.CIM, A3-4603.1

Clinical laboratory tests include some services described as anatomic pathology services

in CPT (i.e., certain cervical, vaginal, or peripheral blood smears). The CPT code 85060

is used only when a physician interprets an abnormal peripheral blood smear for a

hospital inpatient or a hospital outpatient, and the hospital is responsible for the technical

component. When an independent laboratory bills a physician interpretation of an

abnormal peripheral blood smear, the service is considered a complete or global service,

and is not billed under the CPT code 85060. A physician interpretation of an abnormal

peripheral blood smear performed by an independent laboratory is considered a routine

part of the ordered hematology service (i.e., those tests that include a different white

blood count).

The HCPCS code 88150 (cervical or vaginal smears) included both screening and

interpretation in CPT 1986 terminology while the CPT 1987 terminology includes only

screening. A new code, 88151, was added for those smears that require physician

interpretation. Code 88151 is treated and priced in the same manner as code 88150 was

previously treated and priced. Code 88151 with a “-26” modifier is paid when a

physician performs an interpretation of an abnormal smear for a hospital inpatient or

outpatient, and the hospital is responsible for the technical component. The “-26”

modifier for code 88150 is no longer recognized. Code 88151(26) is priced as code

88150(26) would have been priced if the coding terminology had not been revised.

Independent laboratories bill under code 88150 for normal smears and under code 88151

for abnormal smears. However, the fee schedule amount is equivalent.