You Be the Expert: Extending Services

Question: We are extending the emergency room services we now provide and will be opening up an urgent care center that will still be considered part of the ER. Can we charge for bedside lab tests (CBC, electrolytes, urine pregnancy) and be reimbursed through Medicare in an emergency room setting as well as being considered in the facility level of service codes?

California Subscriber


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Answer: Lab and other ancillary procedures are billable and payable by Medicare as long as the physician orders the test and it meets the local Medicare review policy (LMRP) definition of medical necessity. The collection of the specimen can be considered in some type of point system to select the evaluation and management (E/M) level, if that is your facilitys policy. If your policy states that the collection of a lab specimen increases the use of nursing resources, then the effort could be part of the facility level assignment. Whatever policy a facility sets in motion should be followed consistently. HCFA will audit using your facilitys policy.

Lab tests are paid by a fee schedule and exempt (except for anatomical pathology and blood products; anatomical pathology has its own group of APCs) from the APC payments, and will be paid for by Medicare as long as they meet medical necessity. You can bill for the lab tests as well as the E/M service. Also, if a blood product is given, the clinical lab testing associated with the product transfusion (i.e., crossmatching, group and typing) cannot be billed. Blood products are pass-through payments.


- Published on 2000-12-01