Program_Memos / 2002 / AB-02-129

Why This Topic Matters

The memorandum helps readers identify which laboratory claims-processing policies apply, when they take effect, and how CMS framed implementation for contractors and providers. It is especially useful for organizations that manage lab billing workflows, Medicare claims administration, or medical review operations.

Article Sections

1. Scope

   Introduces the memorandum’s subject matter and the Medicare Part B laboratory services policies it addresses. It also places the guidance in the context of the negotiated rulemaking and related federal rulemaking activity.

2. Background

   Summarizes the legislative and policy background for the laboratory services initiative. It references prior CMS memoranda and the broader administrative framework leading up to this guidance.

3. Policy

   Describes the general applicability of the memorandum’s changes across diagnostic clinical laboratory services. It discusses the types of settings and contractors implicated by the policy framework.

4. Implementation

   Provides operational guidance for contractors and providers on implementing the memorandum. The section is organized into subtopics covering service dates, grace-period requests, diagnosis-to-procedure review, terminology clarifications, and provider education.

5. A. Date of Service

   Addresses how date-of-service reporting is handled for laboratory specimen collection and related situations. It also describes what to do when a circumstance does not fit the stated categories.

6. B. Grace Period

   Explains the availability of a temporary implementation grace period and the administrative steps involved in requesting and reviewing it. It includes submission timing, required request elements, and follow-up processing.

7. C. Matching of Diagnosis to Procedure

   Discusses how diagnosis information is reviewed in relation to laboratory services and medical necessity considerations. It also addresses when diagnosis requirements apply across different claim contexts.

8. D. Clarification of the Use of the Term “Screening” or “Screen”

   Clarifies how terminology appearing in laboratory test descriptors is treated for coverage and review purposes. It distinguishes this terminology issue from broader screening-related coverage concepts.

9. E. Provider Education

   Focuses on dissemination of the memorandum’s information to affected audiences. It emphasizes updating provider-facing resources and ensuring timely communication.