Forum - Questions & Answers
Substance Abuse Laboratory Testing
An insurer has taken the position that, for patients in in/outpatient treatment programs for which a per diem is paid (HCPCS Codes H0010-15), all laboratory testing (at the facility or at an independent reference lab) is covered in the per diem amount paid to the treatment program provider, and that the insurer will not pay the reference lab for the testing it conducted. The only source cited was a vague reference to one of the private HCPCS coding manuals.
CMS says that all laboratory testing should be "fee for service" under the Lab Fee Schedule.
Can anyone provide some information on this issue?
Thank you
re: Substance Abuse Laboratory Testing
Many lab services became bundled effective Jan 1 2014. Check this link http://apsmedbill.com/newsletters/2014-02/laboratory-codes-bundled-opps-final-rule it provides the CMS transmittal number. Google that and you should be able to find the info you need.
re: Substance Abuse Laboratory Testing
And here http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM8572.pdf
scroll down to page 11