Reimbursement

• > CPT code 88738 (Total Hemoglobin (Hgb), quantitative and transcutaneous) is the appropriate code to use for SpHb testing.¹
• > Medicare national limitation is $7.10 per test.² Medicaid and commercial payers may reimburse at a different rate than Medicare.
• > CPT Code 88738 is CLIA excluded.³

PDF Resources

REFERENCES

• ¹ CMS transmittal #1912, entitled “Healthcare Common Procedure Coding System (HCPCS) Codes Subject to and Excluded from Clinical Laboratory Improvement Amendments (CLIA) Edits”, change request #6812. Department of Health and Human Services, February 5, 2010.
• ² 2012 CMS Clinical Laboratory Fee Schedule. Available at https://www.cms.gov/ClinicalLabFeeSched/02_ClinLab.asp. Amount paid in the following states differs from the National Limitation Amount: LA = $4.93; WA = $6.53; OH & WV; $5.71; and WY = $6.71.
• ³ Test (CPT-4 Codes) Excluded from CLIA Edits (Within 8000 Series); https://www.cms.gov/CLIA/downloads/CpT4exc.pdf