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.