Procedure for updating procedure
Outpatient hospitals are subject to corrective action, including the recovery of funds, for laboratory services not specifically ordered by a practitioner.MDHHS does not cover: * Screening or routine laboratory testing, except as specified for EPSDT Program or by Medicaid policy; * "Profiles", "batteries" or "panels" of tests that include tests not necessary for the diagnosis or treatment of the beneficiary's specific condition; or * Multiple laboratory tests performed as a part of the beneficiary evaluation if the history and physical examination do not suggest the need for the tests.LABORATORY MDHHS follows Medicare’s current OPPS coverage policies as closely as possible and appropriate.In those instances where program differences require coverage disparity, the differences will be reflected through the application of the MDHHS specific status indicator.
The e GFR test results must report two values on the lab report for beneficiaries: one for American and one for non-African-American, or one value if race is available and able to be used in calculating the value.
For approval of payment, the laboratory procedure(s) must be specific and appropriate to the beneficiary's documented condition and diagnosis.
Reimbursement to the inpatient hospital is through the DRG payment.
Only practitioners should order the serum or urine HCG qualitative method when the beneficiary requires preliminary pregnancy testing.
Nurse-midwives may order only the laboratory tests listed below.