title: Coding, coverage, and compensation for pathology and laboratory medicine services.
abstract: Compensation for pathologist and clinical laboratory services generally depends upon standardized procedural coding systems, the coverage determinations of individual insurance companies, fee schedules that assign reimbursement rates for those services, and contractual compensation arrangements. Procedural coding relies primarily on the American Medical Association's Current Procedural Terminology (CPT) nomenclature. Disease conditions, signs, and symptoms are coded using the International Classification of Diseases, Ninth Revision, Clinical Modification. The single largest health insurance "company" in the United States is the Center for Medicare and Medicaid Services (CMS), and most private insurance companies look to CMS as a model for health services compensation. CMS uses a Physician Fee Schedule and a separate Clinical Laboratory Fee Schedule, whose designs and annual updates differ.
authors.affiliation: ARUP Laboratories, University of Utah School of Medicine, 500 Chipeta Way, Salt Lake City, UT 84108, USA. weissrl@aruplab.com
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Weiss
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D005249:Fees and Charges; D006801:Humans; D007344:Insurance Claim Reporting / Q000191:economics*; D007349:Insurance, Health, Reimbursement; D008484:Medicaid; D006278:Medicare; D010338:Pathology, Clinical / Q000191:economics*; D011216:Practice Management, Medical / Q000191:economics* / Q000458:organization & administration*; D014481:United States