Laboratory Question for the Week of October 15, 2018

Laboratory Compliance Question of the Week

Question:

When submitting an electronic claim for testing, is it the performing lab’s CLIA number included or the referral lab?

Answer:

An electronic claim for laboratory testing will require the presence of the performing (and billing) laboratory’s CLIA number. If tests are referred to another laboratory, the CLIA number of the laboratory where the testing is rendered must also be on the claim.  An electronic claim for laboratory testing must be submitted using several rules established by the Centers for Medicare & Medicaid Services and available in section 40.1.1.2, chapter 16 of the Medicare Claims Processing Manual at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c16.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.