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26.4.1 Reference Labs and Lab Handling Fees
An independent laboratory that forwards a specimen to another laboratory without performing any tests on that specimen may not bill for any laboratory tests. An independent laboratory may only bill the Texas Medicaid Program for tests referred to another laboratory (independent or hospital) if it performs at least one test (that is Medicare-certified to perform) 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 has performed and all tests it is to perform on the specimen. When billing, the Yes box in Block 20 of the CMS-1500 claim form must be marked, the name and provider identifier of the reference lab to where the specimens have been forwarded must be indicated in Block 32, and the provider identifier of the reference lab must be indicated in Block 24-K next to each procedure to be performed by the reference lab.
Only one handling fee may be charged per day, per client, unless specimens are sent to two or more different laboratories; this must be documented on the claim.
An independent laboratory that forwards a specimen to another laboratory (independent or hospital) may bill a handling fee (1-99001) for collecting and forwarding the specimen to the other laboratory if the specimen is collected by routine venipuncture or catheterization. Routine venipunctures or finger, heel, and ear sticks for collection of specimen(s) (2/5-36415) are not a benefit of the Texas Medicaid Program. Family planning agencies must use code 1-99000 with modifier FP to bill their laboratory handling charges for laboratory specimens sent out. As with the physician code 1-99000, only one handling fee may be charged for each laboratory to the agency that sends specimens, regardless of the number of specimens taken.
When family planning test specimens such as Pap smears are collected, providers must direct the laboratory to indicate the claim for the test is to be billed as a family planning service.
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