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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook : 2 Healthy Texas Women (HTW) Program Overview : 2.3 * Services, Benefits, Limitations, and Prior Authorization : 2.3.4 * Laboratory Procedures

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.
More than one lab handling fee may be reimbursed per day if multiple specimens are obtained and sent to different laboratories.
When a provider who renders HTW laboratory services obtains a specimen but does not perform the laboratory procedure, the provider who obtains the specimen may be reimbursed one lab handling fee per day, per client.
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).
If more than one of procedure codes 87480, 87510, 87660, 87661, or 87800 is submitted by the same provider for the same client with the same date of service, all of the procedure codes are denied. Only one procedure code (87480, 87510, 87660, 87661, or 87800) may be submitted for reimbursement, and providers must submit the most appropriate procedure code for the test provided.
Refer to:
Subsection 2.1.1, “Clinical Laboratory Improvement Amendments (CLIA)” in the Radiology and Laboratory Services Handbook (Vol. 2, Provider Handbooks).
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.
HTW follows the Medicare categorization of tests for CLIA certificate holders.
Refer to:
The CMS website at for information about procedure code and modifier QW requirements.

Texas Medicaid & Healthcare Partnership
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