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29.2.26 Laboratory Services
29.2.26.1 Physician Laboratory Services
The CSHCN Services Program reimburses laboratory services ordered by a physician and provided under the personal supervision of the physician in the physician's office laboratory.
A physician office laboratory is a laboratory maintained by a physician or group of physicians for performing diagnostic tests in connection with the physician practice.
If a physician performs more than 100 laboratory tests per year for other providers in his or her laboratory, the lab must be certified by Medicare and the provider must enroll as an independent laboratory with TMHP. Personal supervision is defined as the presence of the physician in the building where the services are performed.
CSHCN Services Program laboratory benefits are provided for medically-necessary professional and technical services ordered by a practitioner who is licensed to do so and provided under the personal supervision of a physician. All laboratory services must be documented in the client's medical record as medically-necessary and referenced to an appropriate diagnosis.
Laboratory tests generally performed as a panel (chemistries, complete blood counts [CBCs], or urinalyses [UAs]) and performed on the same day by the same provider must be billed as a panel regardless of the method used to perform the test.
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