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Bill to Expand Scope for MLTs Passes Committee
The CSP sponsored AB 2281 (Irwin) that would expand the types of tests that a Medical Laboratory Technologist can perform. The law adopted in 2002 that created the MLT license category limited MLTs to moderate complexity testing that did not involve microscopic analysis. California has the most restrictive MLT law in the nation while most states either have no similar limit on the type of moderate complexity tests that can be performed or don't license MLTs at all and defer to federal law.
AB 2281 would simply add three specific moderate complexity procedures blood smear reviews, microscopic urinalysis, and ABO/Rh blood typing to the duties of MLTs. This limited expansion was developed by a Laboratory Workforce Committee under the auspices of the Ca. Hospital Assoc. and lab professionals. It is also consistent with a report on the State of the California Medical Laboratory Technician Workforce released by the Healthforce Center at UCSF in January 2017. That study compared regulation of MLTs by other states, the numbers of MLTs in each state, and their utilization as part of the lab workforce.
These three procedures were chosen because they are all moderate complexity tests, are high volume in many labs, are part of current MLT training programs and performed by MLTs in most other states.
AB 2281 will help clinical labs address the aging of the lab workforce and allow higher trained Clinical Lab Scientists to focus on high complexity testing and the more difficult lab tasks. AB 2281 passed the Assembly Business and Professions Committee on a unanimous vote.
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Changes in Medi-Cal Coverage for Laboratory Services
The first change on FISH testing was made at the request of the CSP after we were informed by a member pathology group that Medi-Cal did not cover 88365. Dues to the structure of the CPT coding the code denoting the second FISH stain procedure but not the first. Medi-Cal did not recognize the nuance of the coding and would deny the first FISH or initial procedure.
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Additional In Situ Hybridization Surgical Pathology Benefit
Effective for dates of service on or after April 1, 2018, CPT-4 code 88365 (in situ hybridization [eg, FISH], per specimen; initial single probe stain procedure) is a new Medi-Cal benefit. The code is split-billable and allows the following modifiers: 26, TC and 90. CPT-4 code 88365 has no age, gender or frequency restrictions and does not require a Treatment Authorization Request (TAR).
This information is reflected in the following provider manual(s):
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Provider Manual(s)
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Page(s) Updated
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Clinics and Hospitals
General Medicine
Obstetrics
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Inpatient Services
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New Sequence Analysis for Molecular Pathology Procedures
Effective for dates of service on or after April 1, 2018, the TP53 test (tumor protein 53, targeted sequence analysis of 2-5 exons) is a Medi-Cal benefit reimbursable under both CPT-4 codes 81404 (molecular pathology procedure, level 5) and 81405 (molecular pathology procedure, level 6) with any of the following numbered Treatment Authorization Request (TAR) criteria:
- All of the following conditions:
- The patient has sarcoma diagnosed before 45 years of age, and
- A first-degree relative with any cancer before 45 years of age, and
- A first or second-degree relative with any cancer before 45 years of age, or a sarcoma at any age; or
- All of the following conditions:
- A tumor belonging to the Li-Fraumeni Syndrome (LFS) tumor spectrum (soft tissue sarcoma, osteosarcoma, pre-menopausal breast cancer, brain tumor, adrenocortical carcinoma, leukemia or lung bronchoalveolar cancer) before 46 years of age, and
- At least one first or second-degree relative with an LFS tumor (except breast cancer if the patient has breast cancer) before 56 years of age or with multiple tumors; or
- The patient has multiple tumors (except multiple breast tumors), two of which belong to the LFS tumor spectrum, and the first occurred before 46 years of age;
- The patient is diagnosed with adrenocortical carcinoma or choroid plexus tumor.
This information is reflected in the following provider manual(s):
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Provider Manual(s)
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Page(s) Updated
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Clinics and Hospitals
General Medicine
Obstetrics
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New Molecular Pathology Benefit:
Testing Retinal Pigment Protein 65kDa
Effective for dates of service on or after April 1, 2018, full gene sequence test RPE65 (retinal pigment epithelium-specific protein 65kDa) is a new Medi-Cal benefit under CPT-4 code 81406 (molecular pathology procedure, Level 7).
Reimbursement for this service requires an approved Treatment Authorization Request and requires providers to document the following:
- Patient has a clinical diagnosis of retinal dystrophy, and
- The decision for gene therapy is contingent on the test results
This information is reflected in the following provider manual(s):
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Provider Manual(s)
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Page(s) Updated
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Clinics and Hospitals
General Medicine
Obstetrics
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CSP Annual Meeting
November 26-December 3, 2018
Hyatt Regency San Francisco
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| California Society of Pathologists
One Capitol Mall Suite 800
Sacramento, CA 95814
Tel : 916-446-6001
Fax : 916-444-7462
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