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Palmetto GBA puts

Date: June 20, 2013
Source: Palmetto GBA

According to 100-4, ch 16,§10, a diagnostic laboratory test must be ordered by the treating physician and the test results must be used in the management of the beneficiary’s specific medical problem. Although some laboratory requisitions allow the ordering physician to designate specimen validity testing (eg: creatinine, oxidant, pH, specific gravity) to ensure that a patient specimen has not been adulterated, the results of this testing are not used in the management of the beneficiary’s medical problem. Therefore, Palmetto GBA has determined that specimen validity testing is a statutorily excluded service.

Reference: IOM 100-04, Ch16,§10



Laboratories that are billing specimen validity should reasses that practice, especially if you are billing Medicare for the same. Consult qualified billing, coding, and legal experts.


last updated on 06/20/2013


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