Critical Access Hospital (CAH) Outpatient Laboratory Service (Rev. 2971, 07-07-14)

by  Jared Staheli
July 9th, 2015

Effective for services furnished on or after the enactment of the Balanced Budget Refinement Act of 1999 (BBRA), Medicare beneficiaries are not liable for any coinsurance, deductible, co-payment, or other cost sharing amount with respect to clinical laboratory services furnished as a CAH outpatient service. This change is effective for claims with dates of service on or after November 29, 1999.

For CAH bill type 85X, the laboratory fees are paid at 101 percent of reasonable cost. When the CAH bills a 14X bill type as a non-patient laboratory specimen, it is paid on the clinical laboratory fee schedule.

References:

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