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December 2016 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 3 Inpatient Hospital (Medical/Surgical Acute Care Inpatient Facility) : 3.1 General Information : 3.1.4 Services Included in the Inpatient Stay

3.1.4
The following services are included in the inpatient stay and are not separately reimbursed:
Whole blood and packed red blood cells. Inpatient services include whole blood and packed red blood cells that are reasonable and necessary for treatment of illness or injury. Whole blood and packed red blood cells that are available without cost are not reimbursed by Texas Medicaid.
Laboratory, radiology, and pathology services. Inpatient services include all medically necessary services and supplies ordered by a physician to include laboratory, radiology, and pathology services.
Note:
Ultrasound interpretations in the inpatient hospital setting will be denied if they are billed by the attending physician. Services that are billed by the attending physician are included in the facility fee and are not reimbursed separately.
Note:
All providers of laboratory services must comply with the rules and regulations of the Clinical Laboratory Improvement Amendments (CLIA). Providers not complying with CLIA will not be reimbursed for laboratory services.
Refer to:
Subsection 1.1, “Provider Enrollment and Reenrollment,” in Section 1, “Provider Enrollment and Responsibilities” (Vol. 1, General Information) for more information about enrollment procedures.
Subsection 2.1.1, “Clinical Laboratory Improvement Amendments (CLIA),” in Radiology and Laboratory Services Handbook (Vol. 2, Provider Handbooks) for more information about CLIA.
The Medicaid Managed Care Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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