Library: Policy

317:30-5-102. Coverage for children

Issued 7-27-95

     Coverage of laboratory services for children is as follows:

• (1) Inpatient services.
  • (A) Claims for inpatient anatomical pathology must be billed by the individual pathologist performing the examination.
  • (B) Inpatient pathology consultations are compensable.  Claim form must include referring physician, diagnosis and test(s) for which the consultation was requested.
• (2) Outpatient services.
  • (A) Outpatient clinical laboratory services are covered when performed in conjunction with an Early and Periodic Screening Diagnosis and Treatment EPSDT) examination.  The claim must be documented with name of attending physician.
  • (B) Medically necessary outpatient clinical laboratory services provided in conjunction with physician office visits are compensable under EPSDT.