Washington Administrative Code
Title 182 - Health Care Authority
WASHINGTON APPLE HEALTH
Chapter 182-540 - Kidney disease program and kidney center services
KIDNEY CENTER SERVICES
Section 182-540-180 - Laboratory services
Universal Citation: WA Admin Code 182-540-180
Current through Register Vol. 24-18, September 15, 2024
(1) Laboratory services included in the composite rate, performed by either the facility or an independent laboratory, must not be billed separately except as provided for in (b) of this subsection:
(a)
Standard end-stage renal disease (ESRD) lab tests are included in the composite
rate when performed at recommended intervals (see billing instructions for
current list).
(b) The standard
ESRD lab tests referred to in (a) of this subsection can be reimbursed
separately from the composite rate only when it is medically necessary to test
more frequently:
(i) Proof of medical
necessity must be documented in the client's medical record when billing for
more frequent testing. A diagnosis of end-stage renal disease is not
sufficient;
(ii) The claim must
include information on the nature of the illness or injury (diagnosis,
complaint or symptom) requiring the performance of the test(s); or
(iii) An ICD-9CM diagnosis code may be shown
in lieu of a narrative description.
(2) All separately billable, ESRD laboratory services must be billed by and reimbursed to the lab that performs the test.
11-14-075, recodified as §182-540-180, filed 6/30/11, effective 7/1/11. Statutory Authority: RCW 74.08.090, 74.09.510, 74.09.520, 74.09.522, and 42 C.F.R. 405.2101. 03-21-039, § 388-540-180, filed 10/8/03, effective 11/8/03.
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