The insurance company Aetna has changed its requirements for practices that offer in-office surgical pathology testing, according to the American Academy of Dermatology (AAD). The insurance company will now require these practices to be both certified in regard to the Clinical Laboratory Improvement Amendments (CLIA) and accredited by the College of American Pathologists (CAP) in order to receive payments from the company for surgical pathology services.
According to the AAD, the new certification requirements for practices that offer surgical pathology services will apply to both the technical and professional components of services billed in the CPT-4 code range 88300-88314 and 88342. Aetna is requiring practices to obtain CAP credentialing by August 1; practices that do not comply will need to refer Aetna patients to in-network labs, such as Quest Diagnostics and AmeriPath, including the Dermpath Diagnostics division.
While the actual deadline for these new requirements is August 1, Aetna suggests that practices submit CLIA and CAP accreditation by May 1 to avoid a “gap in payment.”
The following codes will be impacted by these new requirements: surgical pathology (88300-88309), special stains (88312-88314) – including histochemical staining with frozen section(s) – and pathology consultation (88342).
