TMPPM 2008 > Texas Medicaid Services > Family Planning Services > Procedure Codes and Reimbursement Amounts

20.7.3.2 Laboratory Procedures-Title XlX Only

Medicaid family planning service providers must document all laboratory services ordered in the client's medical record as medically necessary and reference an appropriate diagnosis. Any test specimen sent to a laboratory for interpretation should not be billed on the family planning provider's claim. The laboratory bills the Texas Medicaid Program directly for the tests it performs.

All providers of laboratory services must comply with the rules and regulations of the Clinical Laboratory Improvement Amendments (CLIA). Providers not complying with CLIA are not reimbursed for laboratory services. Only the office or lab actually performing the laboratory test procedure and holding the appropriate CLIA certificate may bill for the procedure.

If a provider does not perform the laboratory procedure, the provider may be reimbursed one lab handling fee a day, per client, unless multiple specimens are obtained and sent to different laboratories. Procedure code 1-99000 with modifier FP is paid for handling and/or conveyance of the specimen for transfer from the provider's office to a laboratory.

Handling fees are not paid for Pap smears or cultures. When billing for Pap smear interpretations, the claim must indicate that the screening and interpretation were actually performed in the office (place of service [POS] 1) by using the modifier SU, e.g., 5-88150-SU.

Forward the client's name, address, Medicaid number, and a family planning diagnosis with any specimen, including Pap smears, to the reference laboratory so the laboratory may bill the Texas Medicaid Program for its family planning lab services.

When family planning test specimens, such as Pap smears, are collected, providers must direct the laboratory to indicate that the claim for the test is to be billed as a family planning service, i.e., the procedure must be billed with a family planning diagnosis.

For a complete list of Title XIX laboratory procedures, providers can refer to the Texas Medicaid fee schedules located on the TMHP website at www.tmhp.com/file library/file library/fee schedules.