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Independent Laboratory
26.1 Enrollment 26-2
26.1.1 Medicaid Managed Care Enrollment 26-2
26.2 Clinical Laboratory Improvement Amendments (CLIA) 26-2
26.2.1 CLIA Requirements 26-2
26.2.2 CLIA Regulations 26-2
26.2.3 Limits of Waiver and Physician-Performed Microscopy Procedure (PPMP)
CLIA Certificates 26-2
26.2.3.1 Waiver Certificate 26-2
26.2.3.2 PPMP Certificates 26-3
26.3 Reimbursement 26-3
26.3.1 Texas Health Steps (THSteps) Outpatient Laboratory Services 26-3
26.4 Benefits and Limitations 26-4
26.4.1 Reference Labs and Lab Handling Fees 26-4
26.4.2 Repeated Procedures 26-4
26.4.2.1 Modifier 91 26-4
26.4.2.2 Modifier 76 26-4
26.4.3 Laboratory Paneling 26-5
26.4.3.1 Chemistry Tests 26-5
26.4.4 Cancer Screening, Colorectal 26-5
26.4.5 Complete Blood Count (CBC) 26-6
26.4.6 Helicobacter Pylori (H. Pylori) 26-6
26.4.7 Microquantitative Sweat Test 26-7
26.4.8 Organ or Disease Panels 26-7
26.4.8.1 Basic Metabolic Panel (5-80048) 26-7
26.4.8.2 General Health Panel (5-80050) 26-7
26.4.8.3 Electrolyte Panel (5-80051) 26-7
26.4.8.4 Comprehensive Metabolic Panel (5-80053) 26-7
26.4.8.5 Obstetric Panel (5-80055) 26-7
26.4.8.6 Lipid Panel (5-80061) 26-7
26.4.8.7 Renal function Panel (5-80069) 26-7
26.4.8.8 Acute Hepatitis Panel (5-80074) 26-8
26.4.8.9 Hepatic Function Panel (5-80076) 26-8
26.4.8.10 TORCH Antibody Panel (5-80090) 26-8
26.4.9 Ferritin and Iron Studies 26-8
26.4.10 Laboratory Services for Clients on Dialysis 26-8
26.4.11 Transfusion Medicine 26-8
26.4.12 Diagnosis Requirements 26-8
26.4.13 Breast Cancer (BRCA) 26-8
26.4.13.2 Authorization Requirements 26-9
26.4.13.3 Prognostic Breast and Gynecological Cancer Studies 26-9
26.5 Claims Information 26-10
26.5.1 Electronic Filing for Laboratory Providers 26-10
26.5.2 Claim Filing Resources 26-10
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