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December 2016 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 6 Renal Dialysis Facility : 6.2 Services, Benefits, Limitations, and Prior Authorization : 6.2.9 Laboratory and Radiology Services : 6.2.9.2 In-Facility Dialysis—Nonroutine Laboratory

6.2.9.2
The following procedure codes are considered necessary, nonroutine tests. They must be submitted separately from the dialysis charge when performed in the renal dialysis facility or by an outside laboratory that bills the facility for laboratory services. All nonroutine laboratory and radiology tests beyond the recommended frequencies below must be medically necessary.
If additional in-facility laboratory testing is medically necessary beyond the nonroutine frequencies identified below, providers must submit the claim with modifier 91 to indicate the billed laboratory procedure is medically necessary. The billing provider must also submit documentation supporting the medical necessity with the claim and maintain the documentation in the client’s medical record.
Once a Month
 
Every 3 Months
 
Every 6 Months
 
Annually
 
A handling fee (procedure code 99001) for nonroutine laboratory services may be submitted to Texas Medicaid only if the specimen is obtained by venipuncture or catheterization and sent to an outside lab. The claim form must document that the handling fee is for nonroutine laboratory services.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.