Laboratory

Noridian processes lab services based on the CMS established regulations.

Diagnostic X-ray, laboratory, and other diagnostic tests, including materials and the services of technicians, are covered under the Medicare program. Some clinical laboratory procedures or tests require Food and Drug Administration (FDA) approval before coverage is provided.

A diagnostic laboratory test is considered a laboratory service for billing purposes, regardless of whether it is performed in: A physician's office, by an independent laboratory; By a hospital laboratory for its outpatients or nonpatients; In a rural health clinic; or In an HMO or Health Care Prepayment Plan (HCPP) for a patient who is not a member.

Access the below lab related information from this page.

Clinical Laboratory Improvement Amendments (CLIA)

CMS regulates all laboratory testing (except research) performed on humans in the U.S. through the Clinical Laboratory Improvement Amendments (CLIA). In total, The objective of the CLIA program is to ensure quality laboratory testing. CMS has resources available that address the guidance and coordination and quality control of CLIA as well as:

  • State Agency or Regional Office CLIA contacts
  • Direct Access Testing (DAT)
  • Office of Inspector General (OIG) reports
  • Micro sample pipetting information for laboratories
  • Identifying Best Practices in Laboratory Medicine - a Battelle Project for the Centers for Disease Control and Prevention (CDC)
  • FDA Safety Tip for laboratories on how workload should be calculated when using currently FDA-approved semi-automated gynecologic cytology screening devices

Laboratories Billing for Referred Tests

Section 1833(h)(5)(A) of the Act indicates that a referring laboratory may bill for clinical laboratory diagnostic tests on the clinical laboratory fee schedule when Medicare beneficiaries are provided services by a reference laboratory only if the referring laboratory meets certain conditions.

To ensure a Medicare Administrative Contractor (MAC), Noridian, adds the appropriate edit allowing for the proper billing method and payment, a referring laboratory must attest to which option applies to their billing scenario prior to billing services.

A Laboratories Billing for Referred Tests - Self Attestation is available for provider completion.

  • Complete form and fax or mail it to Noridian Provider Enrollment team for review

Note: Authorized or Delegated Official on file for enrollment file must sign and date (handwritten signature) the form

Resources

 

Last Updated Jun 15, 2018

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

New Waived Tests - Revised CR10198   Oct 02, 2017
New Waived Tests CR10055   May 16, 2017