Question:
Where can I find coverage and billing rules about the 14-day rule?
Answer:
The origin of the “14-day rule” can be found in the Code of Federal Regulations (CFR), Title 42, §414.510 (Laboratory Date of Service [DOS] for Clinical Laboratory and Pathology Specimens). In addition to the regulation, check the following transmittals from the Centers for Medicare & Medicaid Services (CMS) that include payer instructions as well as DOS rules and exceptions:
- Transmittal R1515CP at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1515CP.pdf
- Transmittal R1319CP at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R1319CP.pdf.