Current through Register Vol. 54, No. 7, April 4, 2022
The sum of
any number of the components of a battery of tests shall not exceed the total
charged for the group offering (panel or profile), whether done by automation
or bench testing, whether or not the equipment is available in the facility. A
battery of tests is considered to be those components of a panel or series of
tests which, when combined, mathematically or otherwise, comprise a finished
identifiable laboratory study or studies. Examples are:
1. The components of a metabolic profile or
other automated laboratory study;
2. An MCH, MCV, or other test, as a component
of a C.B.C.;
3. Inclusive of all
ova and parasites in a stool examination.
(b) If the components of a profile or panel
are billed separately, total reimbursement for the components of the panel or
profile shall not exceed the Medicaid/NJ FamilyCare fee allowance for the panel
or profile itself.
(c) In no
instance shall reimbursement exceed the Medicare Fee Schedule.
Where tests are referred by an approved
service laboratory to an approved reference laboratory, the approved reference
laboratory shall be a Medicaid/NJ FamilyCare provider and shall directly bill
the Medicaid/NJ FamilyCare program for the service.
1. The initiating laboratory shall only refer
clinical laboratory tests to laboratories which have a valid CLIA
Identification Number and are Medicaid/NJ FamilyCare approved
policy on reimbursement for visits to the nursing home, residential health care
facility, or to the beneficiary's home by an independent lab for the purposes
of obtaining blood by venous or arterial puncture is as follows:
1. Utilize HCPCS code W8900 for visits to
homebound beneficiaries in their own home or living in a residential health
care facility, group home, or boarding home. This code may be used only once
per trip regardless of the number of patients seen and requires a distance in
excess of 20 miles per round trip.
2. Utilize HCPCS code 36415 for a visit to a
beneficiary in a nursing facility, or Intermediate Care Facility/Mental
Reimbursement will not be made for travel to other sites including, but not
limited to, hospitals, physician offices, or clinics.