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As noted in last week's briefing, CMS issued Pub. 100-04, Transmittal 85 on Feb. 6, 2004, defining how payment is to be made to independent clinical laboratories for tests referred to another laboratories. This rule only applies to independent clinical labs and becomes effective July 1, 2004. Today we will summarize exactly how claims must be submitted under this new regulation.
Charles Root, Ph.D.
Medicare Payment Policy for Referred Tests
Medicare payment is generally made only for tests that independent laboratories actually perform. However, payment may be made to the referring laboratory for tests performed by other labs when the referring laboratory meets one of the following three conditions:
1. It is located in, or is part of, a rural hospital;
2. It is wholly-owned by the reference laboratory; or both it and the
reference laboratory are wholly-owned subsidiaries of the same entity; or
3. It refers no more than thirty (30) percent of the clinical laboratory tests it performs annually to ....
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