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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2013

Coverage for Amylase Testing 


After considering input from physician groups, Harvard Pilgrim is updating its policies to cover amylase testing (CPT 82150) in certain circumstances. In keeping with the Center for Medicare and Medicaid Services (CMS) guidelines, Harvard Pilgrim will continue to deny amylase electrophoretic blood isoenzyme testing billed as multiple counts of CPT 82150 on the same date of service. Additionally, based on a review of clinical literature, Harvard Pilgrim will deny amylase testing when it is performed on the same date of service as lipase testing. This approach is supported by professional medical societies.

Therefore, Harvard Pilgrim will reimburse one count of CPT code 82150 (amylase) provided it is not billed with lipase (83690), either on the same claim or separate claims, for the same member on the same date of service. This change will become effective for claims processed as of July 1, 2013.

Harvard Pilgrim has updated its Obsolete and Unreliable Procedures Payment Policy to reflect these changes.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Joann Peck,
Manager, Network Planning and Administration

Annmarie Dadoly,
Editor

Kristin Edmonston,
Production Coordinator