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23.2.16 Reference Labs and Lab Handling Fees
An independent laboratory may not bill for laboratory tests when the specimen is forwarded to another laboratory without performing any tests on that specimen. An independent laboratory may bill the CSHCN Services Program for tests referred to another laboratory (independent or hospital) only if the independent laboratory performs at least one test and forwards a portion of the same specimen to another laboratory (reference laboratory) to have one or more tests performed. In this instance, the referring laboratory may bill for tests it performs and all tests the reference laboratory performs on the specimen. When billing, the YES box in Block 20 of the CMS-1500 claim form must be marked, the complete name, provider identifier, address, and ZIP code of the outside reference laboratory where the specimen was forwarded must be entered in Block 32, and the TPI of the reference laboratory must be indicated in Block 24j next to each procedure to be performed by the reference laboratory. Enter the TPI in the shaded area of the field. Enter the NPI in the unshaded area of the field.
Only one handling fee may be charged per day, per client, unless specimens are sent to two or more laboratories. If the specimens are divided and sent to multiple laboratories for testing, the referring laboratory or hospital must identify the performing laboratory's complete name, address, and NPI number on each claim.
In both situations, if a specimen is collected by venipuncture or catheterization, an independent laboratory that forwards a specimen to another laboratory (independent or hospital) may bill a handling fee (procedure code 99001) for collecting and forwarding the specimen to the other laboratory.
When billing for laboratory services, providers should use the date the specimen is collected as the date of service. If the specimen is sent to a reference laboratory and the client is an inpatient, the hospital is responsible for payment of these services to the reference laboratory.
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