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December 2016 Texas Medicaid Provider Procedures Manual

Radiology and Laboratory Services Handbook : 2 Independent Laboratory : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.11 Hematology and Coagulation

The following hematology and coagulation procedure codes may be reimbursed by Texas Medicaid:
The following procedure codes are limited to one per day by the same provider:
Procedure codes 85460 and 85461 may be reimbursed for female clients who are 10 through 55 years of age.
Procedure code 85004 will deny if billed on the same day by the same provider as procedure code 85007.
Procedure code 85660 is limited to once per lifetime, any provider. An additional test may be considered on appeal with documentation indicating the provider was unaware the client was tested previously or was unable to obtain client’s medical records.
Providers are encouraged to reference the American Board of Internal Medicine (ABIM) Foundation’s “Choosing Wisely” lists to determine appropriateness of laboratory tests.

Texas Medicaid & Healthcare Partnership
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