BPS and CPT Code List for Fiscal Year 2017

The new 2016-2017 WWC Clinical Services CPT Code List is now available. There are no changes in CPT code rates compared to the previous CPT Code List released January 2016. The current CPT Code List is valid from June 30, 2016 through June 29, 2017. Rates are based on information found on the Centers for Medicare and Medicaid website, under physician fee schedule and clinical laboratory fee schedule. As per CMS, the new CPT codes became effective January 1, 2016. As of June 30, 2016, WWC can no longer reimburse for procedures using 2015 CPT codes. The Bundled Payment System (BPS) has also been updated and can be found on the WWC website.

Starting January 2016 HPV genotyping CPT code 87625 was added to the allowable CPT code list. As of June 30th, WWC has added reimbursement for HPV genotyping to the Bundled Payment System at the C3 level. CPT code 87625 should be used for HPV genotyping reimbursement. HPV genotyping determines if a patient is positive for HPV types 16 and 18, and is commonly used following an atypical squamous cells of undetermined significance (ASCUS) result to determine if the patient is a candidate for colposcopy. 

Effective June 30: When a same day second diagnostic breast procedure (i.e. breast biopsy) is required in order to reach a final breast diagnosis, agencies may now request additional reimbursement at the CPT code procedure rate. Please email the nurse consultant after both procedure results are entered into eCaST for administrative approval and timely reimbursement. 

Please see the fiscal year 2017 Clinical Services Bundled Payment System and CPT Code List to review these changes.

A Brand New B7 for CCGP!

Hello CCGP eCaST Users ☺   It’s your Data Coordinator, Nick Roth, here with a reminder on the changes coming to CCGP billing levels.  

Many of you provided feedback on lack of payment for CCGP cases when no mammogram is provided. We have heard you and are adding a new CCGP B7 level to reimburse $15 when health education and/or a clinical breast exam (CBE) are completed without a mammogram. The new bundles will look like this:

Level	Services	Payment
B 7	Patient navigation to a completed breast cancer screening office visit.	$15
B 8	Patient navigation to a completed screening mammogram.	$45
B 9	Case management to a final diagnosis. The final diagnosis may be cancer or non-cancer.	$105

Follow me on this one: 

Those cases with an error which used to be deleted due to the client not coming in for their mammogram after their CBE will now instead achieve a B7 pay out! 

What used to be a B7, will now be a B8… and you guessed it, the former B8 will become the brand-new level B9! 


The Takeaway:  Do not worry about the CCGP error “CCGP breast screenings must have a mammogram,” as this error will eventually, magically turn from a dreaded red triangle to an awesome green box with a 7 in it!

Note:  this transition with be retroactive to June 30, but applies only to fiscal year 2016 clients, so only clients with CBEs on July 1, 2015 to present. 

One more thing:  Have a lovely day!