Ala. Admin. Code r. 560-X-9-.02
Current through Register Vol. 43, No. 1, October 31, 2024
Section 560-X-9-.02 - Covered ServicesLaboratory Services are professional and technical laboratory services -
(a) ordered and provided by or under the direction of a physician or other licensed practitioner of the healing arts within the scope of his practice as defined by state law;(b) ordered by a physician but provided by a referral laboratory;(c) provided in an office or similar facility other than a hospital outpatient department or clinic; and(d) provided by a laboratory that meets the requirements for participation in Medicare. (1) Laboratory services are restricted to those that are described by procedures in the CPT manual (80000 series) or one of the locally assigned HCPCS codes used only by Medicaid to supplement the listing in the CPT manual.(2) Providers will be paid only for covered services which they are certified to perform and which they actually perform.(3) Physicians who send specimens to independent laboratories for analysis, and laboratories that provide specimen collection services for referral to other laboratories, may bill for a collection fee. This fee shall not be paid to any provider that has not actually collected the specimen from the patient.(4) Routine venipuncture for collection of laboratory specimens may be billed only when sending blood specimens to another site for analysis. The collection fee may not be billed if the lab work is done at the same site where the specimen was drawn, or in a lab owned, operated, or financially associated with the site in which the specimen was drawn. Author: Lynn Sharp, Associate Director, Policy Development Unit
Ala. Admin. Code r. 560-X-9-.02
Rule effective October 1, 1982. Emergency Rule effective October 15, 1990. Amended effective January 15, 1991. Amended: Filed September 8, 1998; effective October 13, 1998. Amended: Filed November 6, 2000; effective December 11, 2000.Statutory Authority: State Plan; Title XIX, Social Security Act; 42 C.F.R. §440.30.