ACLA Challenging Medicare Ruling on Ionized Calcium The American Clinical Laboratory Association is challenging a recent transmittal issued by the Centers for Medicare & Medicaid Services that establishes ionized calcium as a test to be included in the automated multichannel chemistry (AMCC) panel payment algorithm when it is performed as part of the new CPT panel, 80047, Basic metabolic panel (ionized calcium).

Currently, 80047 is paid as the sum of a seven-test panel, plus ionized calcium, which can yield a maximum of $30.51, depending on the local Medicare lab fee schedule. As of July 1, CMS plans to pay for 80047 as an eight-panel test by a crosswalk to 80048, which most carriers pay at $11.83.

In addition, CMS has indicated that for ESRD dialysis patients, CPT 80047 will be considered a composite rate test when the ionized calcium is done to replace serum calcium. What’s more, CMS included ionized calcium in the calculation of the 50/50 rule applicable to ESRD patients. Under this rule, if half or more of the tests in a chemistry panel are included in the ESRD composite rate, then the entire panel is considered part of the composite rate and will not be paid for separately.

ACLA has asked CMS to withdraw Transmittal 83. For details, see upcoming issues of National Intelligence Report and G-2 Compliance Report.