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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 3. Women’s Health Program (Title XIX Family Planning) : 3.3 Services, Benefits, Limitations, and Prior Authorization : 3.3.3 Laboratory Procedures

If the provider who obtains the specimen does not perform the laboratory procedure, the provider who obtains the specimen may be reimbursed one lab handling fee per day, per client. The fee for the handling or conveyance of the specimen for transfer from the provider’s office to a laboratory may be reimbursed using procedure code 99000 and a family planning diagnosis code. More than one lab handling fee may be reimbursed per day if multiple specimens are obtained and sent to different laboratories.
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 by using the modifier SU, procedure performed in physician’s office.
Providers must 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 WHP 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., procedure must be billed with a WHP qualifying diagnosis code).
Refer to:
Subsection 2.2.3, “Laboratory Procedures” in this handbook for more information about family planning laboratory services.
Subsection 3.3, “Services, Benefits, Limitations, and Prior Authorization” in this handbook for the list of WHP diagnosis codes.
Subsection 2.1.1, “Clinical Laboratory Improvement Amendments (CLIA)” in the Radiology and Laboratory Services Handbook (Vol. 2, Provider Handbooks).
WHP laboratory services may be submitted using the following procedure codes:
Appropriate documentation must be kept in the client’s record.
Claims may be subject to retrospective review if they are submitted with diagnosis codes that do not support medical necessity.
If more than one of procedure codes 87480, 87510, 87660, or 87800 is submitted by the same provider for the same client with the same date of service, all of the procedure codes will be denied.

Texas Medicaid & Healthcare Partnership
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