Fees for independent laboratory services shall be the lower of the submitted charge or the appropriate fee from the fee schedules in effect on July 1, 1990:

(1) Annual fees are increased each January 1 based on the forecast of the Gross National Product (GNP) implicit price deflator, but not to exceed the percentage increase granted by the N.C. State Legislature and not to exceed the Medicare maximum fees.

(2) Fees for new services are established based on fees for similar existing services. If there are no similar services the fee is set at the Medicare maximum fee. If there is no Medicare fee available, the fee is established at 60 percent of charges until a Medicare fee is established.

The methodology as addressed in this Rule shall also apply to laboratory services paid to hospital outpatient facilities, physicians, and any provider supplying outpatient laboratory services.

(Authority G.S. 108A-25(b); 108A-54; 108A-55; P.L. 93-369; P.L. 99-272; 42 C.F.R. 447.10; 42 C.F.R. 447.342; Eff. March 1, 1987; Amended Eff. September 1, 1991.)

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