Mont. Admin. R. 37.86.3007 - OUTPATIENT HOSPITAL SERVICES, PROSPECTIVE PAYMENT METHODOLOGY, CLINICAL DIAGNOSTIC LABORATORY SERVICES
(1)
Clinical diagnostic laboratory services, including automated multichannel test
panels (commonly referred to as "ATPs") and lab panels, will be reimbursed on a
fee basis as follows with the exception of hospitals reimbursed under ARM
37.86.3005
and specific lab codes which are paid under ARM
37.86.3020:
(a) The fee for a clinical diagnostic
laboratory service is the applicable percentage of the Medicare fee schedule as
follows:
(i) 60% of the prevailing Medicare
fee schedule for a birthing center or where a hospital laboratory acts as an
independent laboratory, i.e., performs tests for persons who are nonhospital
patients;
(ii) 62% of the
prevailing Medicare fee schedule for a hospital designated as a sole community
hospital as defined in ARM
37.86.2901;
or
(iii) 60% of the prevailing
Medicare fee schedule for a hospital that is not designated as a sole community
hospital as defined in ARM 37.86.2901.
(b) For clinical diagnostic laboratory
services where no Medicare fee has been assigned, but a Medicaid fee has been
assigned, the fee is the amount set in ARM
37.85.212;
or
(c) if there is no Medicare or
Medicaid fee, the service will be reimbursed at hospital specific outpatient
cost to charge ratio as in ARM
37.86.2803.
Birthing centers will be reimbursed the statewide outpatient cost to charge
ratio.
(2) For purposes
of this rule, clinical diagnostic laboratory services include the laboratory
tests listed in codes defined in the HCPCS and listed in the Clinical
Diagnostic Fee Schedule (CLAB) published January 1, 2018.
(3) Specimen collection will be reimbursed
separately for drawing a blood sample through venipuncture or for collecting a
urine sample by catheterization. Specimen collection will be reimbursed as
specified in the department's outpatient fee schedule as adopted in ARM
37.86.3025,
whether or not the specimens are referred to physicians or other laboratories
for testing. No more than one collection fee may be allowed for each patient
visit, regardless of the number of specimens drawn.
Notes
AUTH: 53-2-201, 53-6-113, MCA; IMP: 53-2-201, 53-6-101, 53-6-111, 53-6-113, MCA
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