Clinical laboratory
View all clinical laboratory-related articles >>
Spotlight
Travel allowance for collection of specimens
Read this article to learn more about the travel allowance paid for the collection of specimens.
New process for pathology and laboratory codes
Read this article to learn more about the travel allowance paid for the collection of specimens.
Effective September 19, avoid negative impacts to your claims by providing medical records with your initial claim submissions of the laboratory and pathology codes indicated in this article.
LCD / NCD – policy information
LCD
Search for clinical laboratory-related LCDs using these available resources:
- LCD interactive index tool
- View First Coast’s active / proposed LCDs on CMS’ Medicare coverage database (MCD)
NCDs
Search for clinical laboratory-related NCDs using these available tools:
Medical documentation
Medical record documentation is used to verify that services were billed correctly and to ensure that payment and processing of Medicare claim(s) are accurate and based on sound policy. Find information, tips, and resources regarding medical documentation.
- Model compliance plan for clinical laboratories
- Medicare Provider Compliance Tips
- Complying with documentation requirements for laboratory services
Targeted probe and educate review topics
Education
Utilize educational information from First Coast and CMS on clinical laboratory services.
- Clinical Laboratory Improvement Amendments (CLIA) - CPT codes requiring QW modifier
- Ordering and billing drug assays for your Medicare patients YouTube
- View First Coast’s upcoming events
- Search for CMS upcoming events
- CMS open door forums
CMS sponsors regularly scheduled “Open Door Forums" providing an opportunity for live dialogue between CMS and the stakeholder community at large. - Clinical laboratory fee schedule
- CLIA program and Medicare laboratory services
CMS Internet-only manual (IOM)
The CMS IOMs contain day-to-day operating instructions, policies, and procedures based on statutes, regulations, guidelines, models, and directives.
The following CMS manual contains information specific to clinical laboratory providers:
- Medicare Claims Processing Manual, Chapter 16 - Laboratory services for specific information related to this specialty.
- Medicare Benefit Policy Manual, Chapter 15, Sec.80.1 , for specific information related to covered medical and other health services.
- Medicare National Coverage Determinations Manual, Chapter 1, Part 3 (Sections 170 – 190.34) Coverage Determinations
Resources
Listed below are additional resources identified specifically for clinical laboratory services.
- CMS Clinical labs center (Spotlights, etc.)
- Clinical laboratory fee schedule (fee schedule, regulations, notices, public meetings, code of federal regulations, transmittals)
- National Correct Coding Initiatives Edits (NCCI)
- Clinical Laboratory Improvement Amendments (CLIA) - General information
- Agency for Health Care Administration – Laboratory and in-home services
Stay informed
Subscribe
Stay updated on the latest Medicare information with free email subscriptions from First Coast and CMS.
View archives
Access previously published emails you may have missed.