Carrier Claims Processing - Hospital-Leased Laboratories (Rev. 1, 10-01-03)

by  Jared Staheli
July 9th, 2015

Carriers process claims from hospital laboratories that are leased by physicians and independent laboratories.

Before processing claims for services furnished by a hospital laboratory department operated on a lease or concession basis by a pathologist or by a nonphysician specialist such as a biochemist (with a visiting pathologist or outside independent laboratory doing the hospital’s tissue work), carriers must ascertain if the laboratory has been approved by the RO.

Services furnished by a laboratory that does not meet the hospital laboratory conditions of participation and is operated under a lease arrangement in a domestic emergency hospital are covered only if they are emergency inpatient services payable under Part A.

Additional information concerning nonparticipating emergency hospital services is found in Chapter 3.

References:

• Pub 100-04 Medicare Claims Processing Manual - Chapter 16