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2.2.2 Laboratory Handling Fees and Reference Laboratories
2.2.2.1 Independent Laboratory Providers
An independent laboratory provider may be reimbursed for tests performed in the laboratory and for laboratory handling fees for tests that are forwarded to another laboratory (i.e., reference laboratory).
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 Texas Medicaid for tests referred to another independent or hospital laboratory if it performs at least one test that it is certified by CLIA to perform, and forwards a portion of the same specimen to the other laboratory to have one or more tests performed. The referring laboratory may then bill for tests it has performed on the specimen. When billing, the following information must be on the claim:
• Block 20: "Yes" box must be checked.
•Block 32: The name, address, and ZIP code of the reference laboratory (i.e., the laboratory to which the specimen was referred).
•Block 24-J: The provider number of the reference laboratory must be included next to each procedure to be performed by the reference laboratory.
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 if the specimen is collected by routine venipuncture or catheterization.
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