(1) The medicaid agency pays providers for laboratory services only when the provider:
(a) Is certified according to Title XVII of the Social Security Act (medicare), if required; and
(b) Has a clinical laboratory improvement amendment (CLIA) certificate and identification number.
(2) The agency considers the cost for the handling, packaging, and mailing fee to be included in the payment for lab tests and does not pay these separately.
(3) The agency pays for one blood drawing fee per client, per day. The agency allows additional units for an independent laboratory when the laboratory goes to a nursing facility or a private home to obtain a specimen.
(4) The agency pays for only one catheterization for collection of a urine specimen per client, per day.
(5) The agency pays for automated multichannel tests done alone or as a group, as follows:
(a) The provider must bill a panel if all individual tests are performed. If not every test in a panel is performed, the provider must bill individual tests.
(b) If the provider bills one automated multichannel test, the agency pays for the test at the individual procedure code rate, or the internal code maximum allowable fee, whichever is lower.
(c) Tests may be performed in a facility that owns or leases automated multichannel testing equipment. The facility may be any of the following:
(i) A clinic;
(ii) A hospital laboratory;
(iii) An independent laboratory; or
(iv) A physician's office.
(6) The agency allows a STAT fee in addition to the maximum allowable fee when a laboratory procedure is performed STAT.
(a) The agency pays for STAT charges for only those procedures identified by the clinical laboratory advisory council as appropriate to be performed STAT.
(b) Tests generated in the emergency room do not automatically justify a STAT order. Physicians must specifically order the tests as STAT.
(c) Refer to the fee schedule for a list of STAT procedures.
(7) The agency pays for drug screen charges only when medically necessary and when ordered by a physician as part of a total medical evaluation.
(8) The agency may require a drug or alcohol screen to determine a client's suitability for a specific test.
(9) An independent laboratory must bill the agency directly. The agency does not pay a medical practitioner for services referred to or performed by an independent laboratory.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 26-17-080, s 182-531-0800, filed 8/17/26, effective 9/17/26; WSR 15-03-041, § 182-531-0800, filed 1/12/15, effective 2/12/15. WSR 11-14-075, recodified as § 182-531-0800, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090. WSR 10-19-057, § 388-531-0800, filed 9/14/10, effective 10/15/10. Statutory Authority: RCW 74.08.090, 74.09.520. WSR 01-01-012, § 388-531-0800, filed 12/6/00, effective 1/6/01.]