Ill. Admin. Code tit. 89 § 140.431

Current through Register Vol. 48, No. 44, November 1, 2024

Section 140.431 - Services Not Covered by Independent Clinical Laboratories

a) Payment shall not be made for any service that a clinical laboratory is not Medicare certified to provide.

b) Payment shall not be made for the following clinical laboratory services:

1) Any test which has not been performed on the laboratory's premises, by the laboratory's staff, using the laboratory's equipment and supplies.

2) The collection and handling of specimens obtained for referral to another laboratory.

3) Laboratory tests that are available without charge from other sources, including the Illinois Department of Public Health. The Department will pay, however, for throat cultures when the referring physician determines use of a Department of Public Health laboratory would result in delay in diagnosis and treatment.

4) Sensitivity studies when a culture shows no growth or when a growth is identified as beta hemolytic streptococcus.

5) Tests ordered for Healthy Kids screening purposes.

6) Tests and study of specimens referred as a result of an autopsy examination.

7) Laboratory services provided to recipients eligible for Medicare Part B benefits when the Medicare intermediary determines that the services are not medically necessary.

8) Laboratory services when not specifically required by the condition for which the recipient is being treated.

Ill. Admin. Code tit. 89, § 140.431

Amended at 23 Ill. Reg. 7122, effective June 1, 1999